Customer Experience Specialist I
Care N’ Care (CNC) - Health Plan
Southwestern Health Resources, a national leader in population health, is looking for a qualified Customer Experience Specialist I - Care N’ Care (CNC) to join our Health Plan team.
If you’re looking for a rewarding career at a patient-centered organization with work-life balance and comprehensive benefits, we want to hear from you.
Work location: Southwestern Health Resources, 1603 Lyndon B. Johnson Freeway, Farmers Branch, TX 75234.
Work environment: Health Plan.
Please note: The Customer Experience Specialist I - Care N’ Care (CNC) will be an employee of Southwestern Health Resources (SWHR). SWHR is a clinically integrated network formed by Texas Health Resources (THR) and University of Texas Southwestern Medical Center (UTSW).
- Full Time; 40 hours per week; Rotating shift.
- Must work 8-hour shifts (8:00am -5:00pm, 9:00am-6:00pm, 10:00am-7:00pm, 11:00am-8:00pm) from Monday to Friday between 8:00am – 8:00pm (CST) from April 1st to September 30th during the year and from Sunday to Saturday between 8:00am – 8:00pm (CST) from October 1st to March 31st.
- This is a Hybrid position, requiring occasional onsite workdays based on department business needs.
- In-person attendance required at department meetings, trainings and/or other department authorized activities, at the above-mentioned address or other locations as directed by the department management.
Southwestern Health Resources (SWHR) is a patient-centered clinically integrated network of 29 hospital locations and more than 5,500 physicians and other clinicians. Formed by Texas Health Resources and University of Texas Southwestern Medical Center, two of the region’s leading healthcare systems, SWHR delivers nationally preeminent, highest-quality care in 16 counties across North Texas.
The SWHR Network includes physicians from University of Texas Southwestern Medical Center and Texas Health Resources, as well as more than 2500 independent community Primary and Specialty Care Physicians. In partnership, our team implements physician-driven, value-based care strategies to coordinate care for more than 700,000 patients, across 16 counties in North Texas, resulting in lower costs and high-quality care.
In 2020, the Centers for Medicare & Medicaid Services (CMS) released the annual financial and quality results. Based on the report, SWHR is one of the nation’s leading Next Generation Accountable Care Organizations (ACO), having saved nearly $120 million since joining the program in 2017.
SWHR is the parent organization of Care N’ Care Insurance Co., a leading regional Medicare Advantage health plan organization that serves approximately 17,000 patients in North Texas.
- High School Diploma or equivalent required.
- Bachelor’s Degree preferred.
- Highly prefer 2 years’ experience in Customer Service, Sales or Account Management in Medicare, Medicare Advantage, or other applicable Health Plan.
- Prefer 2 years’ experience with PPO's and HMO's, Employer Group and Commercial insurance.
- Prefer 2 years multi-functional high volume customer interaction handling experience.
Skills & Abilities
- Must be a fast learner and ability to multitask between multiple systems to complete required 90-day training program.
- Thorough knowledge of CMS guidelines processes and systems.
- Excellent problem solving and organizational skills as well as strong interpersonal communication skills.
- Must possess strong oral and written communication skills, both in person and telephonically.
- Must possess planning and problem-solving skills and be skilled in diplomacy regarding de-escalation and call control.
- Ability to work on special projects independently or as a team Excellent knowledge of Microsoft Office suite of products
The Customer Experience Specialist I will serve customers via telephonic, electronic, and in person methods and should always be prepared to facilitate support in this manner.
- Provide exceptional service across entire health plan customer base via telephonic, electronically or in person methods as applicable. Serve health plan member population, prospective members, sales agents and healthcare providers with issues including but not limited to benefits and eligibility validation, claims status and complex claims routing, billing, enrollment, provider search, PCP assignment and appointment setting, provider portal questions, benefit education, appointments and RSVP processing, assist with incoming enrollment facilitation, may assist in supporting health plan events, prior authorization status, pharmacy inquiries, provider dispute, appeals and grievance and other inquiries as presented.
- Identify proper protocol routing, triage, and escalation as necessary as well as full accountability of follow through and close out, including clear and relative documentation of standard and escalated issues at all times. Maintain personal metrics to established performance levels of the individual and team. Responsibilities may vary depending on seasonal business needs.
- Proactive telephonic outreach and engage customer base as necessary which may involve various customer interactions including but not limited to welcoming new members to the health plan, customer retention and loyalty, quality healthcare initiatives, PCP updates, and other special projects as assigned.
- Research and clearly document complex issues across multiple databases and work with support resources, internally and externally, as applicable to resolve customer issues and/or partner with others to resolve escalated issues and submission of appeals, grievances, disputes and/or complaints from entire customer base.
Why Southwestern Health Resources
As a Southwestern Health Resources employee, you’ll enjoy, comprehensive benefits, including a 401(k) with match; paid time off; competitive health insurance choices; healthcare and dependent care spending account options; wellness programs to keep you and your family healthy; tuition reimbursement; a student loan repayment program; and more.
Additional perks of being an SWHR employee:
- Gain a sense of accomplishment by contributing to a teamwork environment.
- Positively impact patients’ quality of life.
- Receive excellent mentorship, comprehensive training and dedicated clinical and administrative leadership resources.
- Enjoy opportunities for growth.
Explore Southwestern Health Resources Careers for more information and to search all career opportunities.
Our Recruitment team invites you to contact us with any questions at [ Link removed ] - Click here to apply to Customer Experience Specialist I - Care ’N Care Health Plan - Southwestern Health Resources (SWHR)
- Location: Dallas, Texas, United States
- Job Field: Clerical/Admin
- Shift: Rotating
- Schedule: Full-time
- Account Management
- Business Requirements
- Claim Processing
- Content Management