Customer Service Representative (Medicare)

About Us

OmniCare365 is a trusted outsource customer care company with an authentic people first mentality. We pride ourselves on aligning with our Clients to provide exceptional brand value with customers through every experience.

Benefits offered

• Paid Time Off
• Dental, medical, vision, life insurance

Applicants are required to complete a 7-year background & employment check and 9 panel drug screening.

Position Summary

The purpose of this role is to facilitate phone-based customer interaction to address complex member needs and provide recommendations on services that may help close gaps in care for our member and/or our member's family. This role is expected to advocate on behalf of our members in a compassionate manner to meet their healthcare needs. Advocate builds trust with members across their health care lifecycle.

Job Components and Primary Responsibilities:

· Advocate for the member and/or caller by making the interaction hassle-free. Some examples would include contacting providers, pharmacies, or ancillary providers.

· Compassionately own problem through to resolution on behalf of the member in real time or through comprehensive and timely follow-up with the member.

· Effectively ensures members are connected to appropriate specialists and/or enrolled in the correct programs, based on member’s needs and eligibility.

· Demonstrate knowledge of applicable health care terminology (e.g., medical, dental, behavioral, vision)

· Demonstrate knowledge of applicable products/services (e.g., benefit plans, disability, OTC, HRA,)

· Ensure compliance with applicable legal/regulatory requirements (e.g., HIPAA, state/regional requirements)

· Maintain knowledge of information/process changes due to healthcare reform by referring to applicable company resources (e.g., dependent age, removal of lifetime limits, free preventive care services, Loss of Medicaid)

· Demonstrate knowledge of established workflows and support processes (e.g., available resources, Medicaid state specifics)

· Identify inaccurate/inconsistent information found in systems/tools and communicate to appropriate resources

· Communicate common problems/questions presented by callers to appropriate Subject Matter Experts to drive continuous improvement

· Educate callers on self-service resources available to them and on their responsibilities regarding their health care coverage

· Refer members/callers to other resources applicable to their questions/issues where appropriate (e.g., pharmacists, prior authorizations, billing department, transportation, etc.)

Call Types:

- Medical benefits, eligibility, and claims

- Terminology and plan design

- Billing inquiries

- Pharmacy benefits, eligibility and claims

- Correspondence requests

- Accurately capture member grievances and file determination requests

· Compassionately educate members about the fundamentals of health care benefits including:

- Managing health and well being

- Offer Next Best Actions on account and follow up appropriately

- Assist members in appointment scheduling to proactively address gaps in care

- Provider education and choosing a quality care provider

- Maximizing the value of their health plan benefits

- Pre-authorization and pre-determination requests and status

- Research complex issues across multiple applications and work with support resources to resolve customer issues

· Meet the performance goals established for the position in the areas of: efficiency, call quality, customer satisfaction, first call resolution, Advocate4Me, compliance, customer follow-up, and attendance.

· Provide compassion and maximize use of community services, support programs, and resources available to member.

· Complete follow up with member as appropriate.

Qualifications

Advocates are experienced in member tools, benefit interpretation and accurate documentation to interpret situation and proactively address member issues. Advocates in this position will proactively engage members in new opportunities to close gaps in care.

Education and Experience

High school diploma or GED is acceptable.

· 2+ years in a Customer Service environment or equivalent Customer Service skills and experience

· 1 year Experience in Health Care/Insurance environment required (familiarity with medical terminology, health plan documents, claims, or benefit plan design are examples).

Knowledge, Skills, and Abilities

· Demonstrated ability to display empathy and compassion throughout every interaction.

· Demonstrated ability to quickly build rapport and respond to customers in a compassionate manner by identifying and exceeding customer expectations (responding in respectful, timely manner and delivering on commitments).

· Demonstrated ability to listen skillfully, collect relevant information, determine immediate requests and identify the current and future needs of the member.

· Ability to overcome objections and persuade members to take action / change behavior.

· Ability to utilize multiple systems/platforms while on a call with a member – strong computer skills and technical aptitude.

· Proficient problem-solving approach to quickly assess current state and formulate recommendations.

· Proficient in translating healthcare-related jargon and complex processes into simple, step-by-step instructions customers can understand and act upon.

· Flexibility to customize approach to meet all types of member communication styles and personalities.

· Excellent conflict management skills including:

· Professionally and adeptly resolve issues while under stress

· Diffuse conflict and member distress

· Demonstrate personal resilience

· Strong verbal and written communication skills. Solid time management skills.

· Strong attention to detail.

· Bi-lingual candidates desired (English/Spanish).

Physical Requirements and Work Environment

· Frequent speaking, listening using a headset, sitting, use of hands/fingers across keyboard or mouse, handling other objects, long periods working at a computer.

Ability to work regularly scheduled shifts within our hours of operation, where lunches and breaks are scheduled, with the flexibility to adjust daily schedule, and work over-time and/or weekends, as needed.

This job description is not designed to cover or contain a comprehensive listing of activities, duties, or responsibilities that are required of the employee. Duties, responsibilities, and activities may change, or new ones may be assigned at any time with or without notice.

OmniCare365 is an equal opportunity employer. All qualified applicants will receive consideration for employment without regard to race, color, religion, sex, disability, age, sexual orientation, gender identity, national origin, veteran status, or genetic information. OmniCare365 is committed to providing access, equal opportunity, and reasonable accommodation for individuals with disabilities in employment, its services, programs, and activities. To request a reasonable accommodation, contact Human Resources at 580-262-4350 ext. 200.

Job Type: Full-time

Pay: $15.00 per hour

Benefits:

• Dental insurance
• Health insurance
• Life insurance
• Paid time off
• Vision insurance

Schedule:

• 8 hour shift
• Day shift
• Holidays
• Monday to Friday

Application Question(s):

• Do you consent to receive text messages from OmniCare365?
• Do you AGREE that you will be able to (1) Follow strict attendance guidelines during the training program?

Education:

• High school or equivalent (Required)

Experience:

• Call center: 1 year (Required)
• health: 1 year (Preferred)

Work Location: In person