Amerihealth Caritas Health Plan Washington , DC 20319
Your career starts now. We're looking for the next generation of health care leaders.
At AmeriHealth Caritas, we're passionate about helping people get care, stay well and build healthy communities. As one of the nation's leaders in health care solutions, we offer our associates the opportunity to impact the lives of millions of people through our national footprint of products, services and award-winning programs. AmeriHealth Caritas is seeking talented, passionate individuals to join our team. Together we can build healthier communities. If you want to make a difference, we'd like to hear from you.
Headquartered in Philadelphia, AmeriHealth Caritas is a mission-driven organization with more than 30 years of experience. We deliver comprehensive, outcomes-driven care to those who need it most. We offer integrated managed care products, pharmaceutical benefit management and specialty pharmacy services, behavioral health services, and other administrative services. Discover more about us at www.amerihealthcaritas.com.
Under the direct supervision of the Operations Supervisor, is responsible for responding in a timely, professional and courteous manner to all customer (member, provider and other customers) inquiries. This includes outbound member and/or provider phone calls or correspondence regarding benefit, eligibility or customer issues. Makes outreach welcome calls to new members and conduct Health Risk Assessment Surveys as needed. Provides member education and assist members with PCP selection and assignments. Follows internal processes and procedures to ensure all activities are performed in accordance with departmental and company policies and procedures.
You must be a resident of the District of Columbia to be considered for this role.
Services calls and correspondence from members and/or providers; identifies and/or responds to inquiries, dissatisfaction, complaints and grievances. Documents all calls in inquiry tracking system. Applies established protocols to ensure resolution is provided and presented in a clear and accurate manner. Facilitates problem resolution and acts as a customer advocate.
Conducts telephonic outreach to new plan members to conduct a new member welcome call as well as conducts the Health Risk Assessment Survey as required by each state.
Establishes, retains, and deepens relationship with new and existing member and providers through inbound and outbound calls.
Accurately and concisely documents customer responses in the health care system with the ability to triage members, based on responses, to the appropriate area.
Makes follow up calls, and conducts additional research as needed.
Researches member/provider and/or enrollment issues utilizing department procedures, reference materials and internal and external systems. Accurately updates member/provider information in all appropriate systems.
Identifies member/provider issues and refers to appropriate departments. Monitors inquiries forwarded to other departments and follows through to ensure timely resolution. Follows up on outstanding inquiries and works with department staff to identify and resolve areas of non-compliance. Distinguishes between routine and significant issues and notifies management of any issue which could negatively impact service.
Reviews phone activity and quality reports to self-monitor performance, quality and productivity standards. Discusses deficiencies/problems with the supervisor to adjust behavior and work activities as appropriate.
Maintains a balance of productivity, quality and timeliness of job accountabilities.
Utilizes AT&T Language Line and the Telecommunications Digital Device (TDD) when necessary to service non-English speaking or hearing impaired members
Creates and supports an environment which fosters teamwork, cooperation, respect and diversity. Establishes and maintains positive communication and professional demeanor with other employees and clients at all times. Adheres to organizational policies and procedures; supports and carries out the Mission and Values. Demonstrates and supports commitment to corporate goals and mission.
Attends required training on an as needed basis.
Performs other related duties and projects as assigned.
High School diploma or GED
Associate Degree Preferred
1-3 years customer service/contact center experience strongly preferred.
At least 1 year of outbound contact center experience, desired
Healthcare or Managed Care experience preferred.
Minimum 45 wpm typing skill preferred.
Working knowledge of PC applications in a windows based environment.