CareOregon is a healthcare organization seeking a Customer Service HRS Specialist to serve as the initial point of contact for members and providers. The role involves providing advanced customer service and support for inquiries related to Health-Related Services, ensuring effective communication and resolution of issues.
Responsibilities:
- Respond to inquiries originating from a wide range of customer groups including members, providers and other departments and organizations (e.g., community-based organizations, regulatory bodies such as the Oregon Health Authority, etc.)
- Communicate with customer groups via telephone, email and text as appropriate
- Research, verify and resolve a broad array of inquiries, both simple and complex, related to Health-Related Services
- Assist members with applying for Health-Related Services and obtaining information about the status of their requests
- Provide clear communications, timely responses and high-level customer service
- Use online tracking systems to document all activities and communications related to each Health-Related Services inquiry, request, status and outcome
- Receive and apply updates on current, evolving policy and process changes related to Health-Related Services
- Perform ongoing analyses of data and information to identify opportunities for improvement in operational efficiencies
- Collaborate with teams inside and outside of the department to share information, obtain information and resolve customer inquiries
- Partner closely with the Authorization team to gather and compile complete and accurate information for requests and coordinate any necessary outreach
- Complete (off phone) administrative tasks and project work in an efficient and timely manner
- Adhere to all Health Insurance Portability and Accountability Act (HIPAA) requirements and organizational standards related to protected health information, privacy and confidentiality
- Create and update job aids, reference information and other documentation as needed
- Participate in cross-departmental workgroups as needed
Requirements:
- Minimum 3 years' customer service experience including 2 years supporting healthcare members, providers or health-related insurance providers, vendors or related entities
- Minimum 1 year experience in Call Center
- Knowledge of or ability to quickly learn Oregon Administrative Rules (OARs), Federal laws and other regulatory agencies that relate to medical health, Medicaid and Medicare Industry
- Knowledge of the basic concepts of Managed Care
- Knowledge of principles of organizational change and ability to act as a change agent
- Knowledge of Health-Related Services (HRS) requirements and processes
- Ability to learn and apply Oregon Administrative Rules (OARs), Federal Laws and various agency regulations as they relate to processing Health Related Services
- Ability to effectively use phone system and system reports
- Strong computer and data analysis skills
- Excellent interpersonal skills, customer service and strong active listening skills
- Excellent reading, spoken and written communication skills
- Ability to proactively work to build and improve team operations
- Ability to work under pressure in a complex and rapidly changing environment
- Basic mathematical skills
- Excellent problem solving and decision-making skills
- Ability to successfully manage multiple tasks
- Ability to support and comply with organizational policies, procedures, and guidelines
- Ability to participate fully and constructively in department meetings and contribute to decisions
- 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
- Customer service experience with a health insurance carrier/health plan, the Oregon Health Plan and/or roles providing crisis management