Healthcare Representative

  • location: Tampa, FL
  • type: Contract
  • salary: $16.80 per hour
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job description

Healthcare Representative

job summary:
JOB SUMMARY

Responds to member and provider inquiries (phone. written or walk in) regarding all aspects of company business including claims in a professional timely accurate and caring manner while consistently meeting all guidelines.

ESSENTIAL FUNCTIONS ---- Note: The following is not intended to be an exhaustive list of all duties required of this position ---- Key Duties and Responsibilities

  • Responds to member. provider and other inquiries via telephone. correspondence or lobby walk-in while meeting all corporate guidelines and performance standards.
  • Demonstrates appropriate customer-care skills such as empathy active listening courtesy politeness helpfulness and other skills as identified.
  • Records investigates and resolves member complaints as detailed in the Grievance Procedure narrative.
  • Assists in the education of new members and in the re-education of existing members regarding health plan procedures.
  • Track grievance case by line of business for compliance and review.
  • Assist in resolving member and provider complaints
  • Makes decisions that are consistent with the concept of a win-win-win for members associates and company
  • Demonstrates based behaviors such as initiative accountability and value.---
  • Performs skills necessary to create a high-quality customer experience as reflected through acceptable quality audit score and productivity.
  • Peforms other duties as assigned.
Additional Position Responsibilities - Optional ---- ---- MINIMUM QUALIFICATIONS

Education ---- State the minimum required for the job ---- Education Level Education Details Required/Preferred

  • A High School or GED Required
  • An Associate's Degree in a related field Preferred or equivalent work experience
Work Experience ---- State the minimum required for the job ---- Experience Level Experience Details Required/Preferred

  • 1+ year of experience in a call center or customer service environment Required
  • 1+ year of experience in grievance experience Preferred
  • Other Experience within a health care company Preferred
Licenses and Certifications ---- List professional licenses and certifications associated with this job ---- Licenses/Certifications Other Licenses/Certifications Required/Preferred

  • Other Customer service quality or training certifications Preferred
Skills ---- State the minimum required for the job ---- Skill Sets Other Skills Proficiency

  • Demonstrated written communication skills Intermediate
  • Demonstrated interpersonal/verbal communication skills Intermediate
  • Ability to multi-task Ability to multi-task good organizational and time management skills Intermediate
  • Demonstrated organizational skills Intermediate
  • Ability to effectively present information and respond to questions from families members and providers Intermediate
  • Ability to identify basic problems and procedural irregularities collect data establish facts and draw valid conclusions Intermediate
  • Other Ability to act on feedback provided by showing ownership of his or her own development Intermediate
  • Demonstrated time management and priority setting skills Intermediate
  • Ability to work as part of a team Intermediate
  • Other Ability to read. analyzes. and interprets verbal and written instructions Intermediate
  • Other Seeks to build trust. respect and credibility with all partners through full honest consistent and coordinated communication Intermediate
Technology ---- List technical skills associated with the job ---- Technology Other Technology Proficiency Required/Preferred

  • Microsoft Outlook Knowledge of email systems such as Microsoft Outlook sufficient to communicate with both internal and external contacts Beginner Required
  • Microsoft Excel Beginner Required
  • Microsoft Word Beginner Required
  • Healthcare Management Systems (Generic) Beginner Required
Languages ---- List all that apply ---- Languages Other Languages Required/Preferred

 
location: Tampa, Florida
job type: Contract
work hours: 8 to 5
education: High School
experience: 1 Years
 
responsibilities:
  • Responds to member. provider and other inquiries via telephone. correspondence or lobby walk-in while meeting all corporate guidelines and performance standards.
  • Demonstrates appropriate customer-care skills such as empathy active listening courtesy politeness helpfulness and other skills as identified.
  • Records investigates and resolves member complaints as detailed in the Grievance Procedure narrative.
  • Assists in the education of new members and in the re-education of existing members regarding health plan procedures.
  • Track grievance case by line of business for compliance and review.
  • Assist in resolving member and provider complaints
  • Makes decisions that are consistent with the concept of a win-win-win for members associates and company
  • Demonstrates based behaviors such as initiative accountability and value.---
  • Performs skills necessary to create a high-quality customer experience as reflected through acceptable quality audit score and productivity.
  • Peforms other duties as assigned.
 
qualifications:
Additional Position Responsibilities - Optional ---- ---- MINIMUM QUALIFICATIONS

Education ---- State the minimum required for the job ---- Education Level Education Details Required/Preferred

  • A High School or GED Required
  • An Associate's Degree in a related field Preferred or equivalent work experience
Work Experience ---- State the minimum required for the job ---- Experience Level Experience Details Required/Preferred

  • 1+ year of experience in a call center or customer service environment Required
  • 1+ year of experience in grievance experience Preferred
  • Other Experience within a health care company Preferred
 
skills: Human Resources
Equal Opportunity Employer: Race, Color, Religion, Sex, Sexual Orientation, Gender Identity, National Origin, Age, Genetic Information, Disability, Protected Veteran Status, or any other legally protected group status.

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