Customer Service Representative I

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The Customer Service Representative I is the initial point of contact for members of CareOregon and provides excellent customer service delivery relating to the Oregon Health Plan (OHP), Medicaid or Medicare, Group and Individual Medical, Dental, and Mental Health. This entry level position typically focuses on responding to member inquiries but may also assist with outbound calls.

Estimated Hiring Range:

$18.45 - $22.55

Bonus Target:

Bonus - SIP Target, 5% Annual

Current CareOregon Employees: Please use the internal Workday site to submit an application for this job.

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Essential Responsibilities

• Research, verify and resolve inquiries related to Oregon Health Plan (OHP) or Medicare eligibility with guidance from Supervisor and Customer Service Operations Specialists.
• Respond and assist members with Primary Care Provider (PCP) assignments.
• Learn to collaborate with others within Customer Experience and other CareOregon departments to service the member customers and explain OHP or Medicare benefit coverage; provide additional information about community resources when appropriate.
• Collaborate with providers, Division of Medical Assistance Programs (DMAP, and members to ensure effective customer service and the resolution of any health plan issues that arise (e.g., issues with eligibility and systems, etc.).
• Use Call Tracking system to document all communications and activities in relation to members, providers and other customers.
• Maintain confidentiality for all members.
• Coordinate mailing of member materials as needed.
• Treat all members with honesty, courtesy, dignity and respect.
• Provide members with professional, timely and competent service.
• Identify and report any system or process issues; contribute suggestions for improvement.
• Consistently meet or exceed CareOregon Customer Experience standards and expectations related to quality, production and attendance.
• May assist with outbound calls to Medicaid and Medicare members such as welcome and retention calls.

Experience and/or Education

Required

• Minimum 1 year experience working in customer service or health care

Preferred

• Work experience in a call center

Knowledge, Skills and Abilities Required

Skills and Abilities

• Ability to learn and apply Oregon Administrative Rules (OARs), Federal laws and other regulatory agencies that relate to the medical health insurance industry and the Medicaid or Medicare industry
• Strong computer skills including Microsoft Outlook, Word and Excel
• Ability  to  navigate between multiple documents and internet browsers
• Ability to type minimum 35 words per minute preferred
• Strong customer service skills
• Ability to  to interact professionally, patiently and courteously with members in writing and on calls
• Strong active-listening skills
• Strong written and spoken communication skills
• Growing ability to articulate complex issues clearly and  understandably
• Ability to provide clear and concise information and directions as well as follow instructions
• Ability to proactively learn department processes
• Ability to commit to continual improvement in quality and productivity
• Ability to participate fully and constructively in department meetings
• Ability to work in a fast-paced environment and manage multiple tasks
• Research, analytical and problem-solving skills
• Ability to adhere to a set schedule and maintain excellent attendance
• Ability to work effectively with diverse individuals and groups
• Ability to learn, focus, understand, and evaluate information and determine appropriate actions
• Ability to accept direction and feedback, as well as tolerate and manage stress
• Ability to see, read, and perform repetitive finger and wrist movement for at least 6 hours/day
• Ability to hear and speak clearly for at least 3-6 hours/day

Working Conditions

Work Environment(s):         ☒ Indoor/Office    ☐ Community      ☐ Facilities/Security                       ☐ Outdoor Exposure

Member/Patient Facing:     ☐ No                        ☒ Telephonic       ☐ In Person

Hazards:  May include, but not limited to, physical and ergonomic hazards.

Equipment:  General office equipment

Travel:  May include occasional required or optional travel outside of the workplace; the employee’s personal vehicle, local transit or other means of transportation may be used. 

Work Location: Work from home

Schedule: Operation hours are 7 days per week, 8:00AM – 8:00PM

We offer a strong Total Rewards Program. This includes competitive pay, bonus opportunity, and a comprehensive benefits package.  Eligibility for bonuses and benefits is dependent on factors such as the position type and the number of scheduled weekly hours. Benefits-eligible employees qualify for benefits beginning on the first of the month on or after their start date. CareOregon offers medical, dental, vision, life, AD&D, and disability insurance, as well as health savings account, flexible spending account(s), lifestyle spending account, employee assistance program, wellness program, discounts, and multiple supplemental benefits (e.g., voluntary life, critical illness, accident, hospital indemnity, identity theft protection, pre-tax parking, pet insurance, 529 College Savings, etc.). We also offer a strong retirement plan with employer contributions. Benefits-eligible employees accrue PTO and Paid State Sick Time based on hours worked/scheduled hours and the primary work state. Employees may also receive paid holidays, volunteer time, jury duty, bereavement leave, and more, depending on eligibility. Non-benefits eligible employees can enjoy 401(k) contributions, Paid State Sick Time, wellness and employee assistance program benefits, and other perks. Please contact your recruiter for more information.

We are an equal opportunity employer

CareOregon is an equal opportunity employer.  The organization selects the best individual for the job based upon job related qualifications, regardless of race, color, religion, sexual orientation, national origin, gender, gender identity, gender expression, genetic information, age, veteran status, ancestry, marital status or disability. The organization will make a reasonable accommodation to known physical or mental limitations of a qualified applicant or employee with a disability unless the accommodation will impose an undue hardship on the operation of our organization.