Customer Service Representative I

CareOregon is a healthcare organization seeking a Customer Service Representative I to serve as the initial contact for members. This entry-level position focuses on providing excellent customer service related to the Oregon Health Plan, Medicaid, and Medicare, addressing member inquiries, and assisting with outbound calls.

Responsibilities:

• Research, verify and resolve inquiries related to Oregon Health Plan (OHP) or Medicare eligibility with guidance from Supervisor and Customer Service Operations Specialists
• Respond and assist members with Primary Care Provider (PCP) assignments
• Learn to collaborate with others within Customer Experience and other CareOregon departments to service the member customers and explain OHP or Medicare benefit coverage; provide additional information about community resources when appropriate
• Collaborate with providers, Division of Medical Assistance Programs (DMAP, and members to ensure effective customer service and the resolution of any health plan issues that arise (e.g., issues with eligibility and systems, etc.)
• Use Call Tracking system to document all communications and activities in relation to members, providers and other customers
• Maintain confidentiality for all members
• Coordinate mailing of member materials as needed
• Treat all members with honesty, courtesy, dignity and respect
• Provide members with professional, timely and competent service
• Identify and report any system or process issues; contribute suggestions for improvement
• Consistently meet or exceed CareOregon Customer Experience standards and expectations related to quality, production and attendance
• May assist with outbound calls to Medicaid and Medicare members such as welcome and retention calls

Requirements:

• Minimum 1 year experience working in customer service or health care
• Ability to learn and apply Oregon Administrative Rules (OARs), Federal laws and other regulatory agencies that relate to the medical health insurance industry and the Medicaid or Medicare industry
• Strong computer skills including Microsoft Outlook, Word and Excel
• Ability to navigate between multiple documents and internet browsers
• Strong customer service skills
• Ability to interact professionally, patiently and courteously with members in writing and on calls
• Strong active-listening skills
• Strong written and spoken communication skills
• Growing ability to articulate complex issues clearly and understandably
• Ability to provide clear and concise information and directions as well as follow instructions
• Ability to proactively learn department processes
• Ability to commit to continual improvement in quality and productivity
• Ability to participate fully and constructively in department meetings
• Ability to work in a fast-paced environment and manage multiple tasks
• Research, analytical and problem-solving skills
• Ability to adhere to a set schedule and maintain excellent attendance
• Ability to work effectively with diverse individuals and groups
• Ability to learn, focus, understand, and evaluate information and determine appropriate actions
• Ability to accept direction and feedback, as well as tolerate and manage stress
• Ability to see, read, and perform repetitive finger and wrist movement for at least 6 hours/day
• Ability to hear and speak clearly for at least 3-6 hours/day
• Work experience in a call center
• Ability to type minimum 35 words per minute preferred