Member Svcs Rep II (CHC)

About UsCommunity Health Choice, Inc. (Community) is a non-profit Health Maintenance Organization (HMO) licensed by the Texas Department of Insurance. Through its network of more than 10,000 providers and 70 hospitals, Community serves over 260,000 Members with the following programs: Medicaid State of Texas Access Reform (STAR) program for low-income children and pregnant women Childrens 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.Job ProfileJOB SUMMARY: Responsible for accomplishing their primary goal of providing support and rendering Excellent Customer Service by addressing all Health Plan Members calls related to inquiries, questions and concerns in all areas including enrollment, claims, benefit interpretation and the status of authorizations for medical care. Serving assistance to a minimum of 2 Lines up to all Lines of Business. Maintaining confidentiality per HIPAA guidelines.MINIMUM QUALIFICATIONS: 1.Education/Specialized Training/Licensure: High School Diploma or GED2.Work Experience (Years and Area): Two (2) years member/customer service experience in a Managed Care Call Center.3.Management Experience (Years and Area): N/ASPECIAL REQUIREMENTS: 1.Communication Skills: Bilingual Skills Required?

Yes Languages: Spanish/Vietnamese Writing /Composing Correspondence / Reports 2.Other Skills: Analytical Research Statistical P.C. MS Word 3.Work Schedule: Flexible RESPONSIBLE TO: Designated Manager EMPLOYEES SUPERVISED: NoneBenefits and EEOCCommunity employees benefits are provided by Harris Health. These benefits are designed to provide you with flexibility and choices in meeting your specific needs.Community is an Equal Opportunity Employer.Job CategoryAll Jobs