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Req. No

52098

Job Title

Member Services Representative Senior

Market

CHRISTUS System Office

Category

General Operations

Facility

CHRISTUS Corp Irving Offices 919 and 909 Buildings

Address

919 Hidden Ridge
Irving, TX  75038
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Type

FULL TIME

Apply Now Member Services Representative Senior Job in Irving

Summary:

The Customer Service Representative answers all incoming calls from sponsors, members, and providers, researches claim status, and assists in bringing resolution to claim problems. This position is responsible for maintaining positive relationships with physicians, providers, and practice managers within the provider network. Provides high quality service daily to all callers while balancing all phone queue's including specialty. Provides peer-to-peer mentoring and assists with special projects. Ability to utilize de-escalation skills when handling escalations for self or other customer service representatives. Takes ownership of all special projects, assists with training/cross-training and timely responses to questions from peers/management staff. Back-up team leads when delegated to assist. Ability to work independently without direct supervision. Answer incoming calls from members and providers and establishing/maintaining a good rapport, using de-escalating technics as necessary

  • Answer incoming calls from members and providers and establishing/maintaining a good rapport, using de-escalating technics as necessary
  • Provide accurate information regarding eligibility, benefit verification, network and contract status to callers
  • Provide information to callers concerning claims questions, research as necessary to assist in resolving issues related to claims reimbursement
  • Document accurate information concerning calls into computer system
  • Maintain member files, assist with educating, orientation and credentialing providers
  • Maintain current member demographic information, processing address changes in a timely manner
  • Keep the commitment to follow up with members and providers within contractually agreed upon time frame
  • Consistently collaborating with all other departments , serving as a provider liaison with focus on provider retention
  • Follows the CHRISTUS Guidelines related to the Health Insurance Portability and Accountability ACT (HIPAA), designed to prevent or detect unauthorized disclosure of Protected Health Information (PHI)
  • Can lead projects assigned without direct supervision

Requirements:

  • High school diploma or GED equivalency
  • Minimum of 12 months experience in healthcare or medical related field
  • Good typing skills and communication skills
  • Exceeds all department metrics including call quality scoring
  • Operating knowledge of computers using multiple programs simultaneously
  • Good telephonic skills articulating information in an accurate and positive manner
  • Excellent written and oral communication skills
  • Capable of training others and is seen as a subject matter expert

Work Type: 

Full Time

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Member Services Representative Senior