Job Description

Job Description

Community Health Choice, Inc. (Community) is a non-profit managed care organization (MCO), licensed by the Texas Department of Insurance. Through its network of more than 10,000 providers and 94 hospitals, Community serves over 400,000 Members with the following programs:

• Medicaid State of Texas Access Reform (STAR) program for low-income children and pregnant women

• Children’s Health Insurance Program (CHIP) for the children of low-income parents, which includes CHIP Perinatal benefits for unborn children of pregnant women who do not qualify for Medicaid STAR

• Health Insurance Marketplace Plans that offer individual health coverage that includes preventive care, emergency services, prescription drugs, and hospitalization available to all, regardless of pre-existing conditions.

Improving Members' experiences is at the heart of every Community position. We strive every day to make sure that our Members have access to the high-quality health care they need and deserve.

Community is accredited by URAC for its health plan operations. We offer care management programs for asthma, diabetes, and high-risk pregnancy. An affiliate of the Harris Health System (Harris Health), Community is financially self-sufficient and receives no financial support from Harris Health or from Harris County taxpayers.

Skills / Requirements

The Customer Service Advocate II is a position within the Community Health Choice Customer Service Center that is primarily responsible for, but not limited to responding to incoming hotline inquiries as they relate to benefits and eligibility verification, claim status (with the ability to identify if a claim requires reconsideration), authorization status, and complaints, accurate documentation recording of all calls; effective follow-up of calls, as required; and proper electronic routing with effective documentation skills while maintaining confidentiality per HIPAA guidelines.


MINIMUM QUALIFICATIONS:

1. Education/Specialized Training/Licensure: High School diploma or GED.
2. Work Experience (Years and Area): 6 months of Managed Care or health care insurance experience to include Call Center, with claims knowledge.  Cross-functionality in Claims, Benefits and Eligibility for at least two (2) lines of business.
3. Management Experience (Years and Area): N/A
4. Software Operated: Microsoft Office (Word, Excel, Outlook)

SPECIAL REQUIREMENTS: (Check Applicable Areas)

1. Communication Skills:
Above Average Verbal (Heavy Public Contact) ¿
Languages: Spanish or threshold language preferred
Writing /Composing: Correspondence / Reports

2. Other Skills: Analytical, Mathematics, Medical Terminology, Research, MS Word , MS Excel

3. Work Schedule: Flexible, Overtime

4. Other Requirements:
Ability to work independently under minimal direction. Moderate to advanced computer knowledge required.