Customer Service Rep II

At Memorial Hermann, we pursue a common goal of delivering high quality, efficient care while creating exceptional experiences for every member of our community. When we say every member of our community, that includes our employees. We know that when our employees feel cared for, heard and valued, they are inspired to create moments that exceed expectations, while prioritizing safety, compassion, personalization and efficiency. If you want to advance your career and contribute to our vision of creating healthier communities, now and for generations to come, we want you to be a part of our team.

Job Summary

Position is responsible for responding to inquiries from subscribers, providers and the client.

Job Description

Hours for this role: Friday through Monday 4 - 10 hour days, 8 AM to 6 PM

Minimum Qualifications

Education: Some college preferred

Licenses/Certifications: (None)

Experience / Knowledge / Skills:

• Three (3) years Customer Service or Claims processing experience in a TPA or HMO environment
• Bilingual preferred

Principal  Accountabilities

• Front end intake processing and referrals
• Processing order with providers in doctor setting
• Verifying insurance plans, benefits
• Efficiently and courteously responds to telephone inquiries from subscribers regarding benefit verification, claims issues, and eligibility.
• Interprets plan coverage for subscribers and providers to determine correct level of benefit coverage.
• Provides claim filing instructions when needed to subscribers and providers.
• Provides telephone assistance to subscribers and providers, and verifies eligibility as required.
• Promptly returns phone calls resulting from inquiries that require additional research.
• Efficiently enters data simultaneously while listening attentively.
• Provides a high degree of confidentiality/discretion and independent judgment.
• Keeps workstations stocked and organized at all times.
• Performs daily clerical duties, including sending faxes, making copies, and assisting in other areas.
• Efficiently makes requested changes (temporary address changes, ID card requests).
• Ensures safe care to patients, staff and visitors, adheres to all Memorial Hermann policies, procedures, and standards within budgetary specifications including time management, supply management, productivity and quality of service.
• Promotes individual professional growth and development by meeting requirements for mandatory/continuing education, skills competency, supports department-based goals which contribute to the success of the organization; serves as preceptor, mentor, and resource to less experienced staff.
• Demonstrates commitment to caring for every member of our community by creating compassionate and personalized experiences. Models Memorial Hermann’s service standards by providing safe, caring, personalized and efficient experiences to patients and colleagues.
• Other duties as assigned.