CareOregon

Position Description

Position Title: Customer Service Representative I – Bilingual

Date: November 2020

Job Code: A874

Department: Claims and Customer Service

Title of Manager: Customer Service Supervisor

Supervises: Non-supervisory position

Exemption Status: Non-Exempt

Work Hours: Operation hours are 7 days per week, 8:00AM – 8:00PM

General Statement of Duties

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.
• Collaborate with others to explain benefits not covered and provide information on community resources.
• Work with providers, DMAP, or members to resolve health plan problems as needed.
• Document all activities in the Call Tracking system.
• Maintain confidentiality for all members.
• Coordinate mailing of member materials as needed.
• Treat all members with honesty, courtesy, dignity, and respect.
• Provide proactive, value-added service by identifying and reporting system issues.

Outbound Calls/Projects

• May assist with outbound calls to Medicaid or Medicare members, including welcome and retention calls.

Essential Department and Organizational Functions

• Propose and implement process improvements.
• Meet deadlines for workload completion.
• Demonstrate cooperation and teamwork.
• Provide cross-training on specific job responsibilities.
• Meet identified business goals that contribute to departmental goals.

Knowledge, Skills, and Abilities Required

Technical

• Ability to learn and apply Oregon Administrative Rules (OARs), Federal laws, and other regulations.
• Strong computer skills including MS Windows, Word, Excel, and Outlook.

Communication

• Fluency in English and a second language relevant to the population served.
• Strong customer service and active-listening skills.

Physical Skills and Abilities

Education and/or Experience

Required:

• Minimum 1 year experience in customer service or health care.
• Fluency in a second language relevant to the population served.

Preferred:

• Work experience in a call center.

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