HFHP Customer Care Associate

Position Summary

Apply knowledge learned in training and using sound communication skills to guide customers through conversations to investigate and resolve customer telephone interactions. Inquiries can include health benefits, claims, authorizations, prescriptions, providers, eligibility, enrollment, and any other plan related questions. Associates will make each interaction effortless for customers by creating forward-moving, solution-oriented conversations, and providing complete and accurate solutions.

Primary Accountabilities

• Guide customers through their inquiries by using effective critical thinking to strategically discover information.
• Recognize the customer’s inquiry and actively guide the customer through issues to a resolution.
• Resolve unique customer inquiries while adhering to applicable department policies.
• Offer alternative options when a customer’s preferred resolution is not available.
• Provide assistance with customer service walk-in members in a timely and efficient manner.
• Proactively seek assistance from help desk and other resources when a resolution is not obvious.
• Effectively communicates concerns to leadership.

MINIMUM QUALIFICATIONS

• Education: High School/GED
• Licensure: None
• Certification: None
• Work Experience: One year customer service experience.
• Work Experience in lieu of Education: None
• Knowledge/Skills/Abilities
• Must be able to talk and type at the same time and communicate effectively while multitasking.
• Demonstrates successful verbal, interpersonal, and written communication skills.
• Must be able to navigate through multiple screens and computer applications.
• Availability must align with the business needs of the department.

PREFERRED QUALIFICATIONS

• Education: Bachelor's degree in business, Health Care Administration, or related field from an accredited college or university.
• Licensure: No additional
• Certification: No additional
• Work Experience:
• One year health insurance customer service.
• One year experience in a call center environment.
• Knowledge/Skills/Abilities:
• Knowledge of prescription drug coverage concepts, eligibility, coverage, claims, and payment provisions.
• Understanding of processes and procedures associated with member Appeal and Grievance rights including Coverage determination, and Organization determinations.
• Demonstrates proficiency with core applications, including Health First Health Plans’ administrative, pharmacy, utilization management, claims, enrollment, and payment systems, Microsoft applications, as well as member, broker, and provider portals.
• Knowledge of Health First Health Plans’ call center and administrative operations.

PHYSICAL REQUIREMENTS

• Majority of time involves sitting or standing; occasional walking, bending, stooping.
• Extended periods of computer time or at workstation and navigating multiple screens and applications.
• Light work that may include lifting or moving objects up to 20 pounds with or without assistance.
• May be exposed to inside environments with varied temperatures, air quality, lighting and/or low to moderate noise.
• Communicating with others to exchange information.
• Visual acuity and hand-eye coordination to perform tasks.
• Workspace may vary from open to confined, on-site or remote.
• May require travel to various facilities within and beyond county perimeter; may require use of personal vehicle.

ABOUT HEALTH FIRST

At Health First, diversity and inclusion are essential for our continued growth and evolution. Working together, we strive to build and nurture a culture that recognizes, encourages, and respects the diverse voices of our associates. We know through experience that different ideas, perspectives, and backgrounds create a stronger and more collaborative work environment that delivers better results. As an organization, it fuels our innovation and connects us closer to our associates, customers, and the communities we serve.