Job Description:
The Health Plan Call Center Rep Trainee will undergo training that will enable them to advance to a Call Center Rep 1 position. Trainee will provide accurate, prompt, and courteous service to all Cook Children’s Health Plan Member and Providers in a fast-paced call center. Delivers quality services by responding to every inquiry immediately and directing when possible or by collaborating with other CCHP team members involved in the delivery of care to our Members and Providers.
Essential Job Functions:
Benefits/Eligibility/Member updates
Enhances the customer experience by using effective questioning and listening skills when speaking to members and their legal authorized representatives and skillfully diffuse frustrated callers by identifying and finding solutions to member issues. Follows all departmental policies and procedures and maintains confidentiality.
Member Education
Educates and guides Members through the complexities of the programs using clear and concise instructions. Utilizes available resources to help Members make informed decisions regarding their health. Support any efforts to assist members with renewal requirements.
Core System
Updates Member accounts with the correct PCP and demographic information. Documents all Member-related interactions using correct grammar/terminology into CCHP’s core system for the purpose of accurately tracking and analyzing data and trends. Routes/reports and identified trends with providers to the management team.
Issue Resolution
Gathers all relevant information regarding complaints/grievances and accurately document the Members account. Collaborates with other CCHP departments as needed to help resolve Member complaints/grievances ensuring that all information sent in a timely manner to the Compliance Department.
Cultural Sensitivity:
Uses cultural sensitivity during interactions with Members. Schedules face-to-face interpreters for al non-English speaking Members for Medical for medical appointments. Uses CCHP’s TTY hearing impaired phone or Texas Relay to communicate with hearing impaired Members.
Customer Service:
Meets and maintains a score above 87% for: Customer Service Call/Notes Accuracy. This is based on monitoring from Quality Department. Meets and maintains all approved phone metrics while delivering high standards of customer service.