10 days old

Customer Service Representative - Process Executive

Plano, TX 75074
  • Job Code


Responsible for inbound phone inquiries primarily dealing with either:

  • Member benefits and eligibility related to the Medicaid, CHP and FHP product lines or

  • Provider benefits, eligibility, PEP and claim status, member pharmacy calls, utilizing prior approval skills (ACP/DME and CCD) and placing outbound calls on a routine basis.

  • Resolve issues with respect to benefits and eligibility by researching documentation, system information or gaining knowledge from other employees, management or departments.
  • Interact with customers, document call specifics and demonstrate quality program behaviors to create an outstanding relationship with each caller.

  • Work with outside vendors as needed to answer questions or resolve issues.

  • Respond to member correspondence/email in writing utilizing an existing Customer Service system letter to effectively respond to members.

  • Conduct orientation to new members by providing an overview of the members plan and pertaining administrative policy.


  • Demonstrate awareness, motivation, and technical skills to assist in the development and growth of the customer service teams and help to identify process improvements.

  • Assist in department/company projects, as needed, i.e. provide feedback about the customers experience.


  • High School Diploma, GED, or Equivalent work experience

  • Must be computer literate and able to multi-task i.e. document call experience while using the Quality Program.

  • Excellent communication and interpersonal skills.

  • Bilingual fluency in English and Spanish

Preferred Qualifications:

  • Healthcare/Insurance environment (familiarity with medical terminology, health plan documents, or benefit plan design)

  • Social work, behavioral health, disease prevention, health promotion and behavior change (working with vulnerable populations)

  • Sales or account management experience

  • Customer Service Experience

Domain Skills

SNo Primary Skill Proficiency Level * Rqrd./Dsrd.
1 IVR NA Desired
2 Call Center HC NA Desired
3 Customer Service-Healthcare NA Desired

* Proficiency Legends

Proficiency Level Generic Reference
PL1 The associate has basic awareness and comprehension of the skill and is in the process of acquiring this skill through various channels.
PL2 The associate possesses working knowledge of the skill, and can actively and independently apply this skill in engagements and projects.
PL3 The associate has comprehensive, in-depth and specialized knowledge of the skill. She / he has extensively demonstrated successful application of the skill in engagements or projects.
PL4 The associate can function as a subject matter expert for this skill. The associate is capable of analyzing, evaluating and synthesizing solutions using the skill.

Posted: 2021-01-05 Expires: 2021-02-03
Sponsored by:
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Sponsored by:
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Customer Service Representative - Process Executive

Plano, TX 75074

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