Customer Service Specialist - Office Or Home-Based

Qlarant is a not-for-profit corporation that partners with public and private sectors to create high quality, safe, and efficient delivery of health care and human services programs. We have multiple lines of business including population health, utilization review, managed care organization quality review, and quality assurance for programs serving individuals with developmental disabilities. Qlarant is also a national leader in fighting fraud, waste and abuse for large organizations across the country. In addition, our Foundation provides grant opportunities to those with programs for under-served communities.

Are you looking for an opportunity to combine your excellent Customer Service, communication and research skills with your knowledge of healthcare? Do you approach your work with a strong sense of urgency and thrive in fast-paced environments? If this describes you, Qlarant has the perfect career opportunity! As a member of our Investigations MEDIC team, the Customer Service Specialist performs clerical/administrative duties related to reports of potential fraud, waste and abuse from Medicare Part C&D beneficiaries.

Please Note:

• The starting rate is $19/hour (non-negotiable).
• Qlarant's associates receive an excellent benefits package that includes health, dental, vision, short-term and long-term disability, generous sick, vacation and holiday leave, and two retirement plans. We also offer a collaborative and inclusive work environment.
• The preferred location for this position is our Dallas office located near the Galleria Dallas. Once you've successfully completed training (8-12 weeks), you would be eligible to work a hybrid schedule that requires only 2 days in the office each week.
• Well qualified candidates living in North Central Texas* 40 miles or more from our office located at 14643 Dallas Pkwy, Dallas, TX 75254 are eligible to be home-based. We cannot make exceptions to the North Central Texas and 40 mile requirements.
  • North Central Texas Counties: Collin, Dallas, Denton, Ellis, Erath, Hood, Hunt, Johnson, Kaufman, Navarro, Palo Pinto, Parker, Rockwall, Somervell, Tarrant and Wise.

Essential Duties and Responsibilities:

• Communicates with beneficiaries, plans, pharmacies, and providers as needed to resolve complaints.
• Provides information to investigative and medical staff.
• Evaluates the facts of a complaint and researches additional information as necessary.
• Compiles findings and determines if appropriate for presentation to triage team.
• Assists in preparing weekly and monthly reports of all Customer Service activities.
• Handling a wide variety of complex and confidential situations.
• Performs data entry of complaints into the case management system and a variety of other databases.
• Performs background research on subjects of interest as required for the screening of complaints for triage.
• Drafts and writes correspondence using appropriate letter templates or revises the content based on the facts presented in the complaint.
• May communicate with external customers including beneficiary or individual complainants, representatives from the Senior Medicare Patrol, Plan Sponsors, CMS and others.

To perform the job successfully, an individual should demonstrate the following competencies:

• Analytical - Collects and researches data; Uses experience to complement data.
• Problem Solving - Identifies and resolves problems in a timely manner; Gathers and analyzes information skillfully; Develops alternative solutions; Works well in group problem solving situations; Uses reason even when dealing with emotional topics.
• Oral Communication - Speaks clearly and persuasively in positive or negative situations; Listens and gets clarification; Responds well to questions; Demonstrates group presentation skills; Participates in meetings.
• Written Communication - Writes clearly and informatively; Edits work for spelling and grammar; Varies writing style to meet needs; Presents numerical data effectively; Able to read and interpret written information.
• Teamwork - Balances team and individual responsibilities; Exhibits objectivity and openness to others' views; Gives and welcomes feedback; Contributes to building a positive team spirit; Puts success of team above own interests; Able to build morale and group commitments to goals and objectives; Supports everyone's efforts to succeed.
• Customer Service - Manages difficult or emotional customer situations; Responds promptly to customer needs; Solicits customer feedback to improve service; Responds to requests for service and assistance; Meets commitments.
• Judgment - Displays willingness to make decisions; Exhibits sound and accurate judgment; Supports and explains reasoning for decisions.
• Professionalism - Approaches others in a tactful manner; Reacts well under pressure; Treats others with respect and consideration regardless of their status or position; Accepts responsibility for own actions; Follows through on commitments.
• Computer Skills: Demonstrates working knowledge of data entry and Microsoft Office skills to include Word, Excel and Outlook.
• Other Skills and Abilities - Ability to work with highly sensitive information while preserving the confidentiality of the information.

Education and/or Experience:

• High school diploma or general education degree (GED) required with at least one year related experience and/or training, Customer Service/call center and/or Medicare knowledge preferred; or equivalent combination of education and experience.
• Medical terminology and coding background is plus.
• Working knowledge of Microsoft Office is required.

Qlarant is an Equal Opportunity Employer of Minorities, Females, Protected Veterans, and Individuals with Disabilities.