Job Description

At Memorial Hermann, were about creating exceptional experiences for both our patients and our employees. Our goal is to provide opportunities for our diverse employee population that develop and grow careers in a team-oriented environment focused on patient care.

Every employee, at every level, begins their journey at Memorial Hermann learning about the history of the organization and its established culture built on trust and integrity. Our employees drive this culture, and we want you to be a part of it.

Job Summary

Responsible for responding to member, provider, and plan sponsors inquiries, identifying and resolving complex issues with an overriding goal of providing a positive customer experience with every encounter.

The Customer Service Specialist II uses professional and persuasive communication skills when answering and resolving a wide variety of inquiries while ensuring that confidentiality of customer information is maintained. Able to work independently to resolve inquiries across multiple product lines including Medicare advantage, individual, and/or group insurance plans.

This position will report to the Customer Service Manager.

Job Description

Minimum Qualifications

Education: High School Diploma or GED required, some college preferred

Licenses/Certifications: (None)

Experience / Knowledge / Skills:

* Two (2) years of experience within a Health Plan environment in a Call Center or Operations with knowledge of Medicare Advantage, individual, and/or group insurance plans
* Demonstrated ability to independently handle a high volume of customer inquiries across all product lines including Medicare advantage, individual, and/or group insurance plans
* Working knowledge of Microsoft Excel and Word. Good typing speed and computer navigation skills
* Superior interpersonal skills to communicate with internal and external customers and fellow staff members
* Good analytical and research abilities to triage issues
* Bilingual preferred, but not required
* Demonstrates commitment to the Partners-in-Caring process by integrating our culture in all internal and external customer interactions; delivers on our brand promise of we advance health through innovation, accountability, empowerment, collaboration, compassion and results while ensuring one Memorial Hermann.

Principal Accountabilities

* Efficiently and courteously respond to high-volume calls on multiple lines of businesses, from members, providers, and plan sponsor.
* Interprets appropriate actions that will help resolve members, providers, and plan sponsors issues.
* Documents communications accurately and completely.
* Interprets complex claims issues for adjustments and route to appropriate department for processing.
* Identify accounts that are potentially Fraud Waste & Abuse issues and route to appropriate department for escalation.
* Serves as a Subject Matter Expert and Peer to new Customer Service Representatives (Level I).
* Responds to difficult and complex inquiries raised by internal or external Customer Service staff or other stakeholders such as brokers, groups, members, and providers.
* Communicates, collaborates, and cooperates with internal and external stakeholders in a respectful and responsible manner to enhance relationships and render exceptional service. Adheres to all Compliance/Program Integrity requirements.
* Complies with HIPAA Regulations.
* 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 and skills competency; supports department-based goals which contribute to the success of the organization; serves as preceptor, mentor and resource to less experienced staff.
* Performs other duties as assigned.