Customer Experience Specialist I (REMOTE) SWHR CNC

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Posted 4 days ago United States Salary undisclosed
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Job Description

Southwestern Health Resources (SWHR CIN) seeks to hire a Customer Experience Specialist I to work Full Time supporting the Care N' Care department. Please note: Southwestern Health Resources Clinically Integrated Network (SWHR CIN) is an affiliated company of Texas Health and UT Southwestern. If hired for this position, you will become a SWHR CIN employee rather than a Texas Health or UT Southwestern employee. This position is a Remote/Work from Home opportunity Salary range is Min $14.45 - Max $22.21 - based on relevant experience Work Schedule
• Full Time, 40 hours
• Rotating Shifts • April 1 - September 30, 8 am - 8 pm (CST), Monday through Friday and • October 1 - March 31, 8 am - 8 pm, (CST), Sunday through Saturday, seven days a week Job Description
  • Provide exceptional service across entire health plan customer base via telephonic, electronically or in person methods as applicable. Serve health plan member population, prospective members, sales agents and healthcare providers with issues including but not limited to benefits and eligibility validation, claims status and complex claims routing, billing, enrollment, provider search, PCP assignment and appointment setting, provider portal questions, benefit education, appointments and RSVP processing, assist with incoming enrollment facilitation, may assist in supporting health plan events, prior authorization status, pharmacy inquiries, provider dispute, appeals and grievance and other inquiries as presented.
  • Identify proper protocol routing, triage and escalation as necessary as well as full accountability of follow through and close out, including clear and relative documentation of standard and escalated issues at all times. Maintain personal metrics to established performance levels of the individual and team. Responsibilities may vary depending on seasonal business needs.
  • Proactive telephonic outreach and engage customer base as necessary which may involve various customer interactions including but not limited to welcoming new members to the health plan, customer retention and loyalty, quality healthcare initiatives, PCP updates, and other special projects as assigned.
  • Research and clearly document complex issues across multiple databases and work with support resources, internally and externally, as applicable to resolve customer issues and/or partner with others to resolve escalated issues and submission of appeals, grievances, disputes and/or complaints from entire customer base.
The ideal candidate will possess the following qualifications: Education
  • High School Diploma or equivalent Required
  • Bachelor's Degree Preferred
  • 2 Years Customer Service, Sales or Account Management experience in Medicare, Medicare Advantage, or other applicable Health Plan experience and be comfortable and familiar with PPO's and HMO's, Employer Group, and potentially Commercial insurance Preferred
  • 2 Years Multi-functional High-Volume Customer Interaction handling experience Preferred
Travel Local travel to attend on-site meetings or as requested to the SWHR Corporate Headquarters located at 1603 LBJ Freeway, Farmers Branch, Texas 75234 Skills
  • Must be a fast learner and ability to multitask between multiple systems to complete required 90-day training program.
  • Thorough knowledge of CMS guidelines processes and systems
  • Excellent problem solving and organizational skills as well as strong interpersonal communication skills
  • Must possess strong oral and written communication skills, both in person and telephonically.
  • Must possess planning and problem-solving skills, and skilled in diplomacy regarding de-escalation and call control.
  • Ability to work on special projects independently or as a team
  • Excellent knowledge of Microsoft Office suite of products
Individual Contributor

ADA Requirements
Working Indoors 67% or more
Physical Demands
Sedentary Additional Information
  • Location: Dallas, Texas, United States
  • Job Field: Clerical/Admin
  • Shift: Rotating
  • Schedule: Full-time
  • Pay Basis: Hourly
  • Minimum Salary: US Dollar (USD) 14.45
  • Market Salary: US Dollar (USD): 34.71
  • Maximum Salary : US Dollar (USD) 22.21