Customer Service Representative

The Customer Service Representative works in the MDwise call-center to serve as the initial and primary contact source for all MDwise members and providers. The position acts as a liaison between members, network providers, external agencies, and MDwise. Primary duties include: direct responsibility for the resolution, follow-up, and documentation of member inquiries, grievances/complaints, appeals, requests and concerns; recording member contacts in computer databases; and updating member information as appropriate.

Responsibilities:

• Receive incoming telephone calls and conduct personal conferences with members and network providers.
• Provide prompt, courteous, and accurate responses to inquiries and concerns as defined by organizational standards.
• Participate in ongoing training to ensure full competency in interacting with callers.
• Educate members regarding their benefits, MDwise policies and procedures, benefits coverage, and eligibility and instructs on how to correctly utilize the managed health care system.
• Utilize available systems to provide real time information to members, including eligibility status, POWER Account contributions and transactions, Hoosier Healthwise Package C (CHIP) premium payments, PMP assignments, and all other service and utilization data.
• Educate members regarding their rights and responsibilities.
• Serve as the member’s and/or provider’s advocate to resolve outstanding issues.
• Recognize potential quality issues, such as grievances/complaints and appeals, and process the information accordingly.
• Recognize and respond to the inquiries and concerns of the covered members.
• Document all contacts with members for the purposes of continuity of care and service.
• Schedule transportation services for members.
• Process Primary Medical Provider (PMP) changes within the MDwise network.
• Complete special projects as needed and assigned.
• Perform annual Member Survey as necessary.
• Perform 24-Hour PMP Availability Audits as necessary.
• Perform PMP Access Audit as necessary.
• Assist in the peer training of other customer service representatives.
• Update CSR Training Manual as procedures change or network information changes.
• Maintain confidentiality of all information to which there is access.
• Perform other duties as assigned.

Job Requirements

Knowledge, Skills, and Abilities:

• Ability to communicate effectively with health plan members, staff, healthcare providers and social service providers.
• Ability to effectively and professionally communicate orally and in writing.
• Excellent listening skills.
• Exceptional analytical skills to help ascertain how MDwise can best serve each member.
• Ability to establish and maintain effective working relationships with members/clients, staff (to include delivery system staff), management, providers, and the public.
• Excellent organizational skills.
• Excellent computer skills including keyboarding, Microsoft Excel, Microsoft Word, Microsoft Outlook, and the ability to learn additional databases.

Minimum Qualification, Training, and Experience:

• Minimum of a high school diploma; Associate or Bachelor’s degree preferred.
• Must be willing to work flexible hours, which include some evening and weekend hours.
• Minimum 1-2 years of experience in customer service setting.