Medicare Advantage Provider Call Center Support Specialist - Remote Customer Service and Healthcare Operations

Join a Purpose-Driven Organization and Empower Your Career Growth

At Health Care Service Corporation (HCSC), we're dedicated to making a positive impact on the lives of our members and the communities we serve. As a leading health insurance company, we're committed to providing exceptional customer service, innovative healthcare solutions, and a supportive work environment that fosters growth and development. Our employees are the cornerstone of our business, and we're excited to welcome a new team member to our Medicare Advantage Provider Call Center Support team.

About the Role

We're seeking a highly skilled and compassionate Medicare Advantage Provider Call Center Support Specialist to join our remote team. As a key member of our customer service operations, you'll play a critical role in supporting administrative care management duties, including member and provider outreach, healthcare initiatives, and educational campaigns. If you're passionate about delivering exceptional customer service, have a strong understanding of healthcare operations, and are looking for a challenging and rewarding role, we encourage you to apply.

Key Responsibilities

• Handle a high volume of inbound calls from providers and members seeking pre-authorization or other determining authorization requirements
• Support administrative care management duties, including member and provider outreach, healthcare initiatives, and educational campaigns
• Assist in scheduling care manager and member appointments, respond to member inquiries, and perform data entry and research tasks
• Manage low-risk members for health-related social needs, education, and basic member outreach screenings/inquiries
• Develop written correspondence to internal and external stakeholders, including providers, members, and healthcare professionals
• Collaborate with internal stakeholders to resolve member issues and provide solutions
• Maintain accurate and up-to-date knowledge of healthcare operations, including CMS guidelines and medical terminology

Essential Qualifications

• High school diploma or GED required; 1 year of college preferred
• 2 years of experience with communication systems, including fax, email, and telephone
• 1 year of experience with managed care systems or healthcare systems, such as hospitals, doctor offices, or community-based organizations
• Experience coordinating member needs, providing assistance to members, and analyzing member needs
• Basic knowledge of medical or healthcare terminology
• Knowledge of clinical systems, including claims, enrollment, and documentation
• PC proficiency, including Microsoft Office applications
• Excellent customer service skills, with the ability to communicate effectively with members, providers, and internal stakeholders
• Strong verbal and written communication skills, with the ability to develop clear and concise written correspondence

Preferred Qualifications

• College courses in a medical field, human services, social work, psychology, or a related healthcare field
• Call center experience preferred
• Experience with CMS guidelines preferred
• Experience with precertification systems, including MHK, FACETS, and/or QNXT strongly preferred
• Experience with Verint and Finesse strongly preferred

Skills and Competencies

To succeed in this role, you'll need to possess excellent communication and interpersonal skills, with the ability to work effectively with members, providers, and internal stakeholders. You'll also need to be highly organized, with strong analytical and problem-solving skills, and the ability to prioritize tasks and manage multiple responsibilities. Additionally, you'll need to have a strong understanding of healthcare operations, including medical terminology and clinical systems.

Career Growth Opportunities and Learning Benefits

At HCSC, we're committed to investing in the growth and development of our employees. We offer a range of learning and development opportunities, including:

• Curated development plans to foster growth and promote rewarding careers
• Tuition reimbursement and education assistance programs
• Training and development programs to enhance skills and knowledge
• Opportunities for career advancement and professional growth

Work Environment and Company Culture

We offer a supportive and inclusive work environment that values diversity, equity, and inclusion. Our company culture is built on a foundation of respect, integrity, and compassion, and we're committed to providing a welcoming environment for all employees. As a remote team member, you'll have the flexibility to work from home and maintain a healthy work-life balance.

Compensation, Perks, and Benefits

We offer a robust total rewards package, including:

• Competitive salary range: $17.75 - $27.83 per hour
• Annual incentive bonus plan, subject to the terms and conditions of the plan
• Health and wellness benefits, including medical, dental, and vision coverage
• 401(k) savings plan and pension plan
• Paid time off, including vacation, sick leave, and holidays
• Paid parental leave and disability insurance
• Supplemental life insurance and employee assistance program

Why Join HCSC?

At HCSC, we're dedicated to making a positive impact on the lives of our members and the communities we serve. We're a purpose-driven organization that values diversity, equity, and inclusion, and we're committed to providing exceptional customer service and innovative healthcare solutions. If you're looking for a challenging and rewarding role that aligns with your values and career goals, we encourage you to apply.

How to Apply

If you're excited about this opportunity and think you'd be a great fit for our team, please submit your application, including your resume and cover letter. We can't wait to hear from you!