Customer Service Advocate III

Community Health Choice, Inc. (Community) is a non-profit managed care organization (MCO), licensed by the Texas Department of Insurance. Through its network of more than 10,000 providers and 94 hospitals, Community serves over 400,000 Members with the following programs:

• Medicaid State of Texas Access Reform (STAR) program for low-income children and pregnant women
• Children's 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.
• Community Health Choice (HMO D-SNP), a Medicare Advantage Dual Special Needs plan for people with both Medicare and Medicaid that combines Medicare Part A and Part B benefits, Medicare Part D prescription drug coverage, and Medicaid benefits with additional health benefits like dental, vision, transportation, and more.

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.

Skills / Requirements

JOB SUMMARY :

The Customer Service Advocate III is a position within the Community Health Choice Provider Call Center. The Customer Service Advocate III is primarily responsible for, but not limited to responding to incoming provider hotline inquiries as they relate to benefit and eligibility verification, claim status (with the ability to identify if a claim requires reconsideration), authorization status, and complaints, accurate documentation recording of all provider calls; effective follow-up of provider calls, as required; and proper electronic routing with effective documentation skills. JOB SPECIFICATIONS AND CORE COMPETENCIES Essential Functions

• 40% Ability to respond effectively and timely to inbound calls from provider offices regarding benefits and eligibility, claims processing status, and authorization status.
• 40% Maintains a working knowledge of the claim systems and accurately enters the required information into the designated Customer Relationship Management system (CRM), while adhering to departmental and organizational policies and procedures.
• 10% Maintains a professional behavior and exhibit excellent interpersonal skills
• 5% Works collaboratively with coworkers to deliver member/provider services that meet or exceed member/provider expectations
• 5% Other Duties as assigned

Reports to Position Title: Customer Svc Center Supervisor Employees Supervised Titles: N/A MINIMUM QUALIFICATIONS: Education/Specialized Training/Licensure:

• High School diploma or GED or equivalent

Work Experience (Years and Area):

• Three (3) years Health Care / Plan experience to include Call Center, with claims knowledge.
• Cross-functionality in Claims, Authorizations, Benefits and Eligibility.

Management Experience (Years and Area): N/A Software Proficiencies: Microsoft Office (Word, Excel, Outlook) Other: Ability to work independently under minimal direction. Moderate to advanced computer knowledge required. COMPETENCIES Organizational Core Competencies:

• Customer Focus
• Reliability and Dependability
• Honesty & Integrity
• Achievement Orientation
• Change Management
• Teamwork

• Problem Analysis
• Attention to Detail
• Analytical Thinking
• Responding Sensitively
• Above Average Verbal
• Writing /Composing

INTERPERSONAL SKILLS

• Ensures all interactions are conducive to developing and maintaining a cooperative and productive working environment (both internally and externally).
• Maintains self-control and conducts activities in non-adversarial manner