Customer Support Specialist

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Brief Job Description:

The Customer Support Specialist (Public Health and Prevention Specialist II) aides Specialty Health by performing technical services in providing program information and performs client record update activities. Responds to inquiries received on the customer service toll free and local area phone lines as well as by mail, email, and fax. Provides specific information and updates primarily for the following programs: Children with Special Health Care Needs (CSHCN) Services Program, Kidney Health Care (KHC) Program, and the Hemophilia Assistance Program (HAP). May assist with resource and customer service support for other specialized programs within the office. External inquiries are received from recipients, providers, and the public regarding eligibility status, claims status, benefits, limitations, rules, policies, procedures, and requests to update recipient records. Updates client records either through a manual process or the office’s automated system of record. Assists with analyzing processes to ensure adequate, prompt, and efficient customer service and makes recommendations for changes needed or systems improvements. Reports to the Specialty Health Customer Service Supervisor and is supported by them in regard to scope of work and job functions.

Essential Job Functions (EJFs):

Attends work on a regular and predictable schedule in accordance with agency leave policy and performs other duties as assigned.

(40%) Provides program specific information and performs client record update activities for Specialty Health. Responds to requests for program information and updates received primarily through the customer service phone lines, and those received by fax, mail and/or email for all programs within office. Responds to high call volumes. Responds to information requests, inquiries and updates received from the recipients, providers, other agencies, and the public. Types of inquiries and requests are for eligibility and claims status, explanation of benefits, program limitations, rules, policies, and procedures and for request to change and update recipient records. Maintains quality expectations set out by quality improvement metrics and management.

(30%) Uses Specialty Health’s system of record (both manual and automated) to research information to respond to inquiries and service requests. May refer callers to available providers in their area and to other Health and Human Services programs. Routes calls to appropriate program staff as needed. Prepares special reports or summaries of findings regarding travel reimbursements.

(15%) Monitors operation of manual and automated systems. Assists with mailing customer service documents to ensure prompt, accurate and efficient customer service delivery. Performs quality assurance tests on program processes of record and phone systems, and reports identified problems to the Customer Service Supervisor. Provides technical assistance regarding program sites and pharmacy claim processing to providers including social workers, case managers, regional staff, and pharmacists.

(10%) Researches recipient and provider information on various programs and performs case research to support legislative inquiries, administrative reviews, and fair hearings. Prepares special reports for summaries of findings.

(5%) Other duties as assigned include but are not limited to actively participating and/or serving in a supporting role to meet the agency's obligations for disaster response and/or recovery or Continuity of Operations (COOP) activation. Such participation may require an alternate shift pattern assignment and/or location.

Knowledge, Skills and Abilities (KSAs):

Knowledge of complex Federal and State health and human services programs.

Knowledge of state and federal health and human service guidelines, regulations, and policies.

Knowledge of programs which support client populations served by Specialty Health.

Knowledge of benefits and eligibility determination processes.

Knowledge of individual healthcare needs associated with special health care needs/disabilities and related community-based resources.

Skills in providing customer service to a wide range of customers, including patients, providers, and the public.

Skill in providing technical assistance to providers, clients, and professional staff.

Skills in using multiple manual and automated systems to support business processes.

Skill in navigating and interpreting interagency policies and procedures.

Skill in the use of Microsoft Office products.

Skill in customer service support via phone and email correspondence.

Ability to work and communicate effectively as a team member and in work groups.

Ability to communicate verbally and in writing in an effective, tactful, and diplomatic manner.

Ability to work under pressure and manage multiple assignments with minimal supervision.

Ability to develop and interpret policies and procedures specific to customer service delivery.

Ability to respond to customer complaints in a professional and courteous manner.

Ability to appropriately convey instructions and provide supportive feedback to clients and interested parties.

Registrations, Licensure Requirements or Certifications:

N/A

Initial Screening Criteria:

Required criteria:

At least three years’ experience providing customer/client service experience within a health and human services field.

At least three years’ experience providing technical assistance.

Preferred criteria:

Ability to speak fluently in both English and Spanish.

Additional Information:

N/A

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Active Duty, Military, Reservists, Guardsmen, and Veterans:

Military occupation(s) that relate to the initial selection criteria and registration or licensure requirements for this position may include, but not limited to those listed in this posting. All active-duty military, reservists, guardsmen, and veterans are encouraged to apply if qualified to fill this position. For more information please see the Texas State Auditor’s Job Descriptions, Military Crosswalk and Military Crosswalk Guide at Texas State Auditor's Office - Job Descriptions.

ADA Accommodations:

In compliance with the Americans with Disabilities Act (ADA), HHSC and DSHS agencies will provide reasonable accommodation during the hiring and selection process for qualified individuals with a disability. If you need assistance completing the on-line application, contact the HHS Employee Service Center at 1-888-894-4747. If you are contacted for an interview and need accommodation to participate in the interview process, please notify the person scheduling the interview.

Pre-Employment Checks and Work Eligibility:

Depending on the program area and position requirements, applicants selected for hire may be required to pass background and other due diligence checks.

HHSC uses E-Verify. You must bring your I-9 documentation with you on your first day of work. Download the I-9 Form

Telework Disclaimer:

This position may be eligible for telework. Please note, all HHS positions are subject to state and agency telework policies in addition to the discretion of the direct supervisor and business needs.