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Customer Service Representative I --------------------------------------------------------------- The Customer Service Representative II is the initial point of contact for members of CareOregon and provides excellent customer service delivery relating to the Oregon Health Plan (OHP), Medicaid or Medicare, Group and Individual Medical, Dental and Behavioral Health. This intermediate level position focuses on responding to member inquiries as well as placing outbound calls and assisting with other projects and initiatives. This is a temporary, benefit‑eligible position with an expected duration of approximately 9 months, with the possibility of extension based on program needs and performance Estimated Hiring Range: $18.45 - $22.55 Bonus Target: Bonus - SIP Target, 5% Annual Current CareOregon Employees: Please use the internal Workday site to submit an application for this job. --------------------------------------------------------------- Essential Responsibilities Customer Service Research, verify and resolve inquiries relating to Oregon Health Plan (OHP) or Medicare eligibility with minimal supervision. Respond and assist members with Primary Care Provider (PCP) assignments. Collaborate with others within Customer Experience and other departments within CareOregon to service the member customers and explain OHP or Medicare benefit coverage; provide information on community resources when appropriate. Work collaboratively with providers, DMAP and members to ensure effective customer service and the resolution of any health plan issues that arise (e.g., issues with eligibility and systems). Use Call Tracking system to document all communications and activities in relation to 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. Identify and report any system, information or process issues; contribute suggestions for improvement. Consistently meet or exceed Department and Company standards and expectations including but not limited to quality, production and attendance. Outbound Calls/Projects Conduct outbound calls to Medicaid or Medicare members, such as welcome and retention calls. Conduct health risk inquiries and surveys; determine and coordinate with appropriate resources. Actively participate in other projects and initiatives as assigned. Experience and/or Education Required Minimum 1 year experience working in a health care customer service call center Knowledge, Skills and Abilities Required Knowledge Knowledge of the basic concepts of Managed Care Skills and Abilities 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 Ability to learn basic knowledge of claims operation practices and protocols Ability to learn basic knowledge, including completion requirements of CMS and UB-92 claim forms Ability to learn and apply basic knowledge of CPT, HCPCS, Revenue, and ICD-9/10 coding Ability to type minimum 35 words per minute preferred Strong computer skills including Microsft Outlook, Word and Excel Ability to navigate between multiple documents and internet browsers Excellent customer service skills Ability to interact professionally, patiently, and courteously in writing and on calls Strong active-listening skills Excellent written and spoken communication skills Ability to articulate complex issues clearly and understandably Ability to provide clear and concise information and directions as well as follow instructions Ability to be a positive role model for peers Ability to contribute ideas for processes improvement Ability to commit to improving quality and productivity Ability to participate fully and constructively in department meetings and decisions Ability to work in a fast paced environment and manage multiple tasks Strong research, analytical and problem solving skills Ability to adhere to a set schedule and maintain excellent attendance Ability to work effectively with diverse individuals and groups Ability to learn, focus, understand, and evaluate information and determine appropriate actions Ability to accept direction and feedback, as well as tolerate and manage stress Ability to see, read, and perform repetitive finger and wrist movement for at least 6 hours/day Ability to hear and speak clearly for at least 3-6 hours/day Working Conditions Work Environment(s): ☒ Indoor/Office ☐ Community ☐ Facilities/Security ☐ Outdoor Exposure Member/Patient Facing: ☐ No ☒ Telephonic ☐ In Person Hazards: May include, but not limited to, physical and ergonomic hazards. Equipment: General office equipment Travel: May include occasional required or optional travel outside of the workplace; the employee’s personal vehicle, local transit or other means of transportation may be used. Work Location: Work from home Schedule: Operation hours are 7 days per week, 8:00AM – 8:00PM We offer a strong Total Rewards Program. This includes competitive pay, bonus opportunity, and a comprehensive benefits package. Eligibility for bonuses and benefits is dependent on factors such as the position type and the number of scheduled weekly hours. Benefits-eligible employees qualify for benefits beginning on the first of the month on or after their start date. CareOregon offers medical, dental, vision, life, AD&D, and disability insurance, as well as health savings account, flexible spending account(s), lifestyle spending account, employee assistance program, wellness program, discounts, and multiple supplemental benefits (e.g., voluntary life, critical illness, accident, hospital indemnity, identity theft protection, pre-tax parking, pet insurance, 529 College Savings, etc.). We also offer a strong retirement plan with employer contributions. Benefits-eligible employees accrue PTO and Paid State Sick Time based on hours worked/scheduled hours and the primary work state. Employees may also receive paid holidays, volunteer time, jury duty, bereavement leave, and more, depending on eligibility. Non-benefits eligible employees can enjoy 401(k) contributions, Paid State Sick Time, wellness and employee assistance program benefits, and other perks. Please contact your recruiter for more information. We are an equal opportunity employer CareOregon is an equal opportunity employer.  The organization selects the best individual for the job based upon job related qualifications, regardless of race, color, religion, sexual orientation, national origin, gender, gender identity, gender expression, genetic information, age, veteran status, ancestry, marital status or disability. The organization will make a reasonable accommodation to known physical or mental limitations of a qualified applicant or employee with a disability unless the accommodation will impose an undue hardship on the operation of our organization. CareOregon is a nonprofit, mission-driven health plan, focused on providing care to low-income Oregonians. The CareOregon family includes Columbia Pacific CCO, Jackson Care Connect, Housecall Providers and our work as part of Health Share of Oregon. We also support recruitment for The Collaborative. Our mission is to inspire and partner to create quality and equity in individual and community health. Our vision is healthy communities for all individuals, regardless of income or social factors. Making Healthcare Work for Absolutely Everyone. Let's connect! Add your resume to our Talent Community to stay up to date with relevant career opportunities. Learn more about our benefits and joining CareOregon Click here for more information about jobs at Housecall Providers, part of the CareOregon family. 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. Veterans CareOregon greatly encourages military veterans to apply. CareOregon is a major sponsor of the annual Portland Veterans Stand Down and hiring fair. Ranked #8 in the Health Care Category. Read more about the culture at CareOregon