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, Medicaid or Medicare, Group and Individual Medical, Dental and Mental Health. This entry level position typically focuses on member inquiries, but may assist with outbound calls.
Essential Position Functions
Customer Service
- Research, verify and resolve inquiries relating to Oregon Health Plan or Medicare eligibility with guidance from supervisory and leads.
- Respond and assist members with Primary Care Provider (PCP) assignments.
- Learn to collaborate with others inside and outside department to explain benefits not covered by Oregon Health Plan or Medicare and provide information on community resources when appropriate.
- Work collaboratively with providers, DMAP, or members to ensure effective customer service and the resolution of health plan problems (i.e., eligibility and system) as needed.
- Use online Call Tracking system to document all activities from any mode of communication from 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.
- Provide proactive, value added service by identifying and reporting system/technology issues.
- Consistently meet or exceed Department and Company standards and expectations including but not limited to quality, production and attendance.
Outbound Calls/Projects
- May assist with outbound calls to Medicaid or Medicare members, which may include welcome and retention calls.
Essential Department and Organizational Functions
- Propose and implement process improvements.
- Meet deadlines for completion of workload.
- Maintain agreed upon work schedule.
- Demonstrate cooperation and teamwork.
- Provide cross-training on specific job responsibilities.
- Meet identified business goals that contribute to departmental goals.
- Perform other duties as needed.
Knowledge, Skills and Abilities Required
Technical
- 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 application skills including MS Windows, Word, Excel and Outlook; comfort navigating through multiple documents and internet browsers
- Ability to type minimum 35 words per minute
Communication
- Ability to speak English, as well as a second language relevant to the population served
- Strong customer service skills, including the ability to interact professionally, patiently, and courteously with members over the phone and in person
- Strong active-listening skills
- Strong written and verbal communication skills, preferrably in multiple languages
- Grow in the ability to articulate complex issues in an easy to understand manner
- Ability to educate, give concise information and directions, and follow instructions.
Other
- Results and service oriented
- Ability to integrate rapidly with an existing team and to share ideas
- Ability to proactively learn department processes
- Ability to commit to improving 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 sound problem solving skills
- Ability to adhere to a set schedule and demonstrate excellent attendance
- Ability to work in an environment with diverse individuals and groups
- May require the ability to meet criteria of the CareOregon Telecommuting Guidelines
- Ability to work some evenings, weekends, and holidays to support operation hours of 7 days per week, 8:00AM – 8:00PM
Physical Skills and Abilities
Lifting/Carrying up to 10 Pounds
Pushing/Pulling up to 0 Pounds
Pinching/Retrieving Small Objects
Crouching/Crawling
Reaching
Climbing Stairs
Repetitive Finger/Wrist/Elbow/
Shoulder/Neck Movement
1-3 hours/day
0 hours/day
1-3 hours/day
0 hours/day
1-3 hours/day
0 hours/day
More than 6 hours/day
Standing
Walking
Sitting
Bending
Seeing
Reading
Hearing
Speaking Clearly
0 hours/day
0 hours/day
0 hours/day
0 hours/day
More than 6 hours/day
More than 6 hours/day
More than 6 hours/day
More than 6 hours/day
Cognitive Skills and Abilities
Ability to focus on and comprehend information, learn new skills and abilities, assess a situation and seek or determine appropriate resolution; ability to accept managerial direction and feedback and tolerate and manage stress.
Education and/or Experience
Required:
- Minimum 1 year experience required in customer service or health care
- Fluency through language testing in a second language relevant to the population served
Preferred:
- Work experience in a call center
Working Conditions
- Environment: This position’s primary responsibilities typically take place in the following environment(s) (check all that apply on a regular basis):
☒ Inside/office ☐ Clinics/health facilities ☐ Member homes
☐ Other_________________________________________
- Travel: This position may include occasional required or optional travel outside of the workplace, in which the employee’s personal vehicle, local transit, or other means of transportation may be used.
- Equipment: General office equipment
- Hazards: n/a
Candidates of color are strongly encouraged to apply. CareOregon is committed to building a linguistically and culturally diverse and inclusive work environment.
Veterans are strongly encouraged to apply.
We are an equal opportunity employer. CareOregon considers all candidates regardless of race, color, religion, sex, sexual orientation, gender identity, national origin, age, genetic information, disability, or veteran status.
Visa sponsorship is not available at this time.
