[Hiring] Customer Service HRS Specialist - Bilingual-1 @CareOregon

Role Description

The Customer Service HRS Specialist - Bilingual role serves as the initial point of contact for members, providers, and other external groups for a wide range of inquiries related to Health-Related Services (HRS). The role is responsible for providing advanced customer service to support improved health care delivery and overall community health outcomes. This is an external facing role, and the majority of job duties involve inbound and outbound call work as well as other modes of communication.

This position is eligible for a 3% bilingual pay differential.

Estimated Hiring Range: $28.23 - $34.50

Bonus Target: Bonus - SIP Target, 5% Annual

Essential Responsibilities

• Respond to inquiries from a wide range of customer groups including members, providers, and other departments and organizations.
• Communicate with customer groups via telephone, email, and text as appropriate.
• Research, verify, and resolve a broad array of inquiries related to Health-Related Services.
• Assist members with applying for Health-Related Services and obtaining information about the status of their requests.
• Provide clear communications, timely responses, and high-level customer service.
• Use online tracking systems to document all activities and communications related to each Health-Related Services inquiry.
• Receive and apply updates on current policy and process changes related to Health-Related Services.
• Perform ongoing analyses of data to identify opportunities for improvement in operational efficiencies.
• Collaborate with teams inside and outside of the department to share and obtain information.
• Partner closely with the Authorization team to gather and compile complete and accurate information for requests.
• Complete administrative tasks and project work in an efficient and timely manner.
• Adhere to all HIPAA requirements and organizational standards related to protected health information.
• Create and update job aids, reference information, and other documentation as needed.
• Participate in cross-departmental workgroups as needed.

Qualifications

• Minimum 3 years’ customer service experience including 2 years supporting healthcare members, providers, or health-related insurance providers.
• Minimum 1 year experience in Call Center.
• Fluency through language testing in a second language relevant to the population served.

Preferred Qualifications

• Customer service experience with a health insurance carrier/health plan, the Oregon Health Plan, and/or roles providing crisis management.

Knowledge, Skills and Abilities Required

• Knowledge of Oregon Administrative Rules (OARs), Federal laws, and other regulatory agencies related to medical health, Medicaid, and Medicare.
• Knowledge of the basic concepts of Managed Care.
• Knowledge of principles of organizational change and ability to act as a change agent.
• Knowledge of Health-Related Services (HRS) requirements and processes.
• Ability to learn and apply Oregon Administrative Rules (OARs) and Federal Laws as they relate to processing Health Related Services.
• Ability to effectively use phone systems and system reports.
• Ability to speak English as well as a second language relevant to the population served.
• Strong computer and data analysis skills.
• Excellent interpersonal skills, customer service, and strong active listening skills.
• Excellent reading, spoken, and written communication skills.
• Ability to proactively work to build and improve team operations.
• Ability to work under pressure in a complex and rapidly changing environment.
• Basic mathematical skills.
• Excellent problem-solving and decision-making skills.
• Ability to successfully manage multiple tasks.
• Ability to support and comply with organizational policies, procedures, and guidelines.
• Ability to participate fully and constructively in department meetings.
• Ability to work effectively with diverse individuals and groups.
• Ability to learn, focus, understand, and evaluate information and determine appropriate actions.
• Ability to accept direction and feedback, as well as tolerate and manage stress.
• Ability to see, read, and perform repetitive finger and wrist movement for at least 6 hours/day.
• Ability to hear and speak clearly for at least 3-6 hours/day.

Working Conditions

• Work Environment: Indoor/Office
• Member/Patient Facing: Telephonic
• Hazards: May include physical and ergonomic hazards.
• Equipment: General office equipment.
• Travel: May include occasional required or optional travel outside of the workplace.
• Work Location: Work from home.
• Schedule: Operation hours are 7 days per week, 8:00am – 8:00pm.

Benefits

• Competitive pay and bonus opportunity.
• Comprehensive benefits package including medical, dental, vision, life, AD&D, and disability insurance.
• Health savings account, flexible spending account(s), lifestyle spending account, employee assistance program, wellness program, and discounts.
• Strong retirement plan with employer contributions.
• PTO and Paid State Sick Time based on hours worked/scheduled hours.
• Paid holidays, volunteer time, jury duty, bereavement leave, and more, depending on eligibility.
• 401(k) contributions for non-benefits eligible employees.

Company Description

CareOregon is an equal opportunity employer. The organization selects the best individual for the job based upon job-related qualifications, regardless of race, color, religion, sexual orientation, national origin, gender, gender identity, gender expression, genetic information, age, veteran status, ancestry, marital status, or disability. The organization will make a reasonable accommodation to known physical or mental limitations of a qualified applicant or employee with a disability unless the accommodation will impose an undue hardship on the operation of our organization.