Customer Care Associate

• Assist with in-person, written, and telephonic member inquiries.
• May assist with outbound calls to members, which may include welcome and retention calls.
• Research, verify and resolve inquiries relating to Oregon Health Plan (OHP) or Medicare eligibility, benefit coverage, claims processing, and complaints with guidance from management.
• Assist members with Primary Care Provider (PCP) and dental assignments.
• Learn to collaborate with others inside and outside department to explain benefits not covered and provide information on community resources when appropriate.
• Work collaboratively with providers, Oregon Health Authority (OHA), or members to ensure effective customer service and the resolution of health plan problems (i.e., eligibility and system) as needed.
• Use Call Tracking system to document all activities from any mode of communication from members, providers and other customers.
• Maintain confidentiality for all members in accordance with UHA policies and Health Insurance Portability and Accountability Act (HIPAA) regulations.
• Coordinate mailing of member materials as needed.
• Treat all members with honesty, courtesy, dignity, and respect.
• Provide members with professional, timely and competent service.
• Provide proactive, value-added service by identifying and reporting system/technology issues.
• Essential department and organizational functions.
• Propose and implement process improvements.
• Meet deadlines for completion of workload.
• Maintain agreed upon work schedule.
• Demonstrate cooperation and teamwork.
• Provide cross-training on specific job responsibilities.
• Consistently meet or exceed Department and Company standards and expectations including but not limited to quality, production and attendance.
• Meet identified business goals that contribute to departmental goals
• Comply with organization's internal policies and procedures, Code of Conduct, Compliance Plan, along with applicable Federal, State, and local regulations.
• Maintain a general understanding of the grievances and appeals process according to company policies.
• Keep resource information up to date, accurate and organized.

• High school diploma or equivalent.
• 0-4 years of experience in customer service.
• Ability to learn and apply Oregon Administrative Rules (OARs), Federal laws and other regulatory agencies that relate to the medical health insurance industry.
• Strong customer service skills, including the ability to interact professionally, patiently, and courteously with members over the phone and in person.
• No suspension/exclusion/debarment from participation in federal health care programs (eg. Medicare/Medicaid).

PI238663792