Customer Service Coordinator I

Customer Service Coordinator I

The Customer Service Coordinator I is responsible for advocating for members, providers, and health plans affiliated with the organization. This role will provide exceptional customer service at all times by assisting with referral inquiries, resolving member concerns, responding to general inquiries, educating members on health group programs and services, and ensuring member satisfaction with each interaction.

Qualifications:

• High school diploma or equivalent required.
• 1 year in a customer service role in a medical group setting required.
• Knowledge of medical terminology, general knowledge of Managed Care industry, and ability to understand and explain healthcare concepts to others required.
• Proficient in computer applications and ability to learn and navigate new software and technologies.
• Strong oral and written communication skills, including proper grammar and spelling.
• Strong problem solving and critical thinking skills with attention to detail.
• Ability to perform effectively in a fast-paced, high pressure, and dynamic environment.
• Proven ability to work independently, manage multiple priorities, and prioritize effectively.
• Bilingual (Spanish) preferred.
• At the discretion of DOHC/FHC management, this position has the potential to be a full or hybrid telecommuting position.

Professional Duties:

• Receive and respond to inquiries via phone, email, text, and other channels in a professional and timely manner, using various types of software.
• Provide accurate and relevant information to members regarding referrals/referral status, referral process, health plan programs and services, and other general information inquiries.
• Perform timely referral-related research using available resources to resolve member, provider, and health plan inquiries in accordance with established policies and procedures.
• Document member interactions and encounters in the appropriate software systems with completeness and accuracy.
• Resolve member complaints escalate to member health plan when appropriate.
• Educate members on referral, appeal and grievance processes, PCP assignment, health plan selection, and enrollment in special programs and services; ensuring proper guidance and assistance throughout these processes.
• Conduct outreach to members via phone and text to communicate urgent referral decision details, correct address issues from returned mail, and respond to member inquiries for assistance and information.
• Collaborate with team members, internal departments, and staff across the organization to address complex member issues.
• Participate in training and educational programs offered internally to remain abreast of updates in policies, procedures, workflows and industry regulations to ensure job performance meets expected standards.
• Perform other duties as assigned.

Physical Demands:

• Sitting Approximately 90% of day.
• Standing Approximately 5% of day.
• Walking Approximately 5% of day.
• Lifting 0 - 10 lbs. (equipment, supplies) approximately >5% of day.
• Bending Approximately 5% of day.
• Kneeling <5%.
• Hearing/Visual Acuity Adequate for use with computers and telephone. Approximately 100% of day.
• Computer Highly technical work environment. Must be able to work at least 7 hours a day using keyboard, mouse and monitor.
• Reaching Above head 75 degrees approximately 5% of day.
• Hand grip dexterity Approximately 90% of day.