HP Customer Serv Rep Bilingual

Driscoll Children's Hospital•Corpus Christi, TX

3d•Hybrid

About The Position

The Customer Service Representative is responsible for assisting Members/Providers with healthcare inquiries, concerns, or complaints via telephone. This role requires compassion, innovation, and a commitment to helping others. Travel may be required to our Corpus Christi location for training. The position involves significant phone time, driving first-call resolution, and maintaining accurate documentation. Adherence to HIPAA, regulatory guidelines, and company policies is essential. The representative will navigate complex computer systems, review call history, and communicate important messages to members and providers. Empathy, professionalism, and strong communication skills are key to building effective relationships and resolving customer issues.

Requirements

Minimum of a high school diploma or equivalent
Customer service experience
Strong customer service skills, including courteous telephone etiquette and professionalism
Ability to type a minimum of 35 words per minute
Outstanding communication skills and the ability to understand complex situations to effectively handle escalated customer needs
Analytical skills and the ability to read and interpret data
Problem solving abilities
Ability to work independently and as a part of a team
Proficiency with Microsoft Office applications, particularly Outlook, Word and MS Teams

Nice To Haves

Experience working in a call center or healthcare-related field
Prior understanding and awareness of call center metrics and goals
Prior healthcare experience, in particular, Medicaid Insurance Plans
Knowledge of managed care processes and health insurance coverage
Knowledge of medical terminology

Responsibilities

Assist members and providers by responding to telephone inquiries in a prompt, accurate, and objective manner regarding various healthcare topics including Abuse, Neglect and Exploitation, Authorizations, Behavioral Health, Claims, Complaints, Crisis Calls, Eligibility, Health Insurance Benefits, Locating providers, Pharmacy Benefits, Transportation, and Waste Abuse and Fraud.
Spend approximately 90% of scheduled time on the phone, addressing inquiries based on business needs.
Drive resolution of caller questions and issues on the first call whenever possible.
Ensure proper documentation of calls and resolution actions.
Understand and adhere to HIPAA requirements.
Adhere to Regulatory Guidelines and policies & procedures.
Navigate through complex computer systems to identify the status of an issue and provide appropriate responses.
Review previous call interactions and notes.
Communicate monthly messages to members and providers on a specific need basis.
Deal tactfully and empathetically with members and providers.
Establish and maintain effective working relationships with provider office staff.
Read, comprehend, and verbalize processes and procedures of the organization and health insurance coverage.
Multi-task by utilizing multiple complex computer applications.
Pay close attention to detail.
Identify issues/trends and escalate to Supervisor/Manager when assistance is needed.
Develop relationships with other departments to provide feedback about root cause issues.
Intervene with providers on behalf of the customer to assist with appointment scheduling or connections with specialists.
Assist customers in navigating through the Driscoll Health Plan website and encourage self-sufficiency.
Own problems through to resolution on behalf of the customer in real time or through comprehensive and timely follow-up.
Research complex issues across multiple databases and work with internal departments to resolve customer issues.
Partner with others to resolve escalated issues.
Other duties as assigned.