Customer Service HRS Specialist

Customer Service HRS Specialist

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The Customer Service HRS Specialist 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). (HRS are certain flexible services defined as Health-Related Services by the state of Oregon.) 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.

Estimated Hiring Range:

$28.23 - $34.50

Bonus Target:

Bonus - SIP Target, 5% Annual

Current CareOregon Employees: Please use the internal Workday site to submit an application for this job.

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Essential Responsibilities

• Respond to inquiries originating from a wide range of customer groups including members, providers and other departments and organizations (e.g., community-based organizations, regulatory bodies such as the Oregon Health Authority, etc.).
• Communicate with customer groups via telephone, email and text as appropriate.
• Research, verify and resolve a broad array of inquiries, both simple and complex, 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, request, status and outcome.
• Receive and apply updates on current, evolving policy and process changes related to Health-Related Services.
• Perform ongoing analyses of data and information to identify opportunities for improvement in operational efficiencies.
• Collaborate with teams inside and outside of the department to share information, obtain information and resolve customer inquiries.
• Partner closely with the Authorization team to gather and compile complete and accurate information for requests and coordinate any necessary outreach.
• Complete (off phone) administrative tasks and project work in an efficient and timely manner.
• Adhere to all Health Insurance Portability and Accountability Act (HIPAA) requirements and organizational standards related to protected health information, privacy and confidentiality.
• Create and update job aids, reference information and other documentation as needed.
• Participate in cross-departmental workgroups as needed.

Experience and/or Education

Required

• Minimum 3 years’ customer service experience including 2 years supporting healthcare members, providers or health-related insurance providers, vendors or related entities
• Minimum 1 year experience in Call Center

Preferred

• 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

• Knowledge of or ability to quickly learn Oregon Administrative Rules (OARs), Federal laws and other regulatory agencies that relate to medical health, Medicaid and Medicare Industry
• 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

Skills and Abilities

• Ability to learn and apply Oregon Administrative Rules (OARs), Federal Laws and various agency regulations as they relate to processing Health Related Services
• Ability to effectively use phone system and system reports
• 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 and contribute to decisions
• 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(s): Indoor/Office Community Facilities/Security Outdoor Exposure

Member/Patient Facing: No Telephonic In Person

Hazards: May include, but not limited to, physical and ergonomic hazards.

Equipment: General office equipment

Travel: May include occasional required or optional travel outside of the workplace; the employee’s personal vehicle, local transit or other means of transportation may be used.

Work Location: Work from home

Schedule: Operation hours are 7 days per week, 8:00AM – 8:00PM

We offer a strong Total Rewards Program. This includes competitive pay, bonus opportunity, and a comprehensive benefits package. Eligibility for bonuses and benefits is dependent on factors such as the position type and the number of scheduled weekly hours. Benefits-eligible employees qualify for benefits beginning on the first of the month on or after their start date. CareOregon offers medical, dental, vision, life, AD&D, and disability insurance, as well as health savings account, flexible spending account(s), lifestyle spending account, employee assistance program, wellness program, discounts, and multiple supplemental benefits (e.g., voluntary life, critical illness, accident, hospital indemnity, identity theft protection, pre-tax parking, pet insurance, 529 College Savings, etc.). We also offer a strong retirement plan with employer contributions. Benefits-eligible employees accrue PTO and Paid State Sick Time based on hours worked/scheduled hours and the primary work state. Employees may also receive paid holidays, volunteer time, jury duty, bereavement leave, and more, depending on eligibility. Non-benefits eligible employees can enjoy 401(k) contributions, Paid State Sick Time, wellness and employee assistance program benefits, and other perks. Please contact your recruiter for more information.

We are an equal opportunity employer

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.