Customer Service Representative

The Role 

As a Customer Service Representative for ACO Reach, you will provide beneficiaries, beneficiary family members and/or advocates, providers, and community service organizations with the information to ensure that they receive supportive services, equipment, and supplies needed to promote quality of life and the achievement of beneficiary identified desired outcomes. The Customer Service Representative will empower the members to make informed decisions, provide benefit information and advocate on their behalf when deemed necessary. 

Responsibilities 

• Answer inbound calls from beneficiaries with questions about claims, benefits, eligibility, and prior authorizations. 
• Conduct outbound calls to orient new members to the Belong Health ACO Reach program and assist with care coordination. 
• Collaborate with providers, social workers, discharge planners, and community-based service providers to coordinate care and achieve care plan goals. 
• Facilitate and monitor the implementation of the member care plan in accordance with recommendations by the Interdisciplinary Care Team. 
• Identify nature of issues, independently respond to and resolve non-clinical issues and complaints and escalate clinical issues to appropriate department and staff. 
• Work with members, providers, and staff to identify and resolve member service and retention related issues.  
• Educate potential members/community representatives on plan features, plan benefits, and program admission requirements. 
• Promote a culture of accountability and performance to both meet and exceed personal service vision goals and ensure timely and satisfactory resolution of highly complex, specialized, and non-routine customer issues. 
• Additional duties assigned. 
• Hours: 8:00-4:30pm or 9:00am-5:00pm. 

Requirements 

• 2+ years’ experience in a care coordination, customer service, health care organization, Community Based Organization, or social services environment.  
• Working knowledge of Medicare and Medicaid programs and experience with regulatory requirements and reporting.  
• Demonstrated experience in a managed care or HMO setting is strongly preferred.  
• Knowledge of managed care and / or member services.  
• Knowledge of community services and resources for elders and disabled. 
• Familiarity with coordinated care models is an advantage. 
• Understanding of the needs and dynamics of elder care services, disadvantaged, and disengaged populations. 
• Excellent problem solving, trend identification, and analytical skills, with a demonstrated ability to problem solve effectively and efficiently. 
• Commitment to high ethical standards in all work; protects the privacy of member and Belong data and exercises discretion in handling confidential member information. 
• Excellent oral and written communication skills. 
• Demonstrated PC skills using Microsoft applications. 
• Knowledge of managed care product portfolio, benefits, policies and procedures. 
• Strong active listening, issue assessment and problem-solving skills.  
• Strong organizational and follow-through skills. 
• Preferred Skills: Bilingual (Spanish) a plus. 

Benefits & Perks 

• Employer 401k match up to 4% (Immediate vesting) 
• Medical, dental and vision benefits employer contribution 
• HSA and FSA Plans (Dependent Care and Commuter) 
• Fully covered memberships for EAP coverage  
• Meaningful paid parental leave for all caregivers, including a childcare stipend upon return from parental leave 
• Employer paid short-term, and long-term disability plans  
• Life and AD&D insurance access 
• Fully remote work environment 
• Complimentary access to We Work 
• Generous PTO, including vacation days, sick leave and 11 national holidays 
• Thoughtfully curated monthly events including learning sessions, wellness sessions, and social events 
• Bi-annual company summits  
• Investor network support 

Salary Range  

• $25-$27/hour 

Work Environment   

The work environment characteristics described here are representative of those encountered while performing the essential functions of this job. Reasonable accommodation may be made to enable individuals with disabilities to perform the essential functions  

• The noise level in the work environment is usually quiet    

Health & Safety  

Belong Health and its partners require full vaccination for associates and select contractors who conduct work outside of their home on behalf of Belong Health and its partners. This applies to those who work within our facilities; interact directly with members and patients; attend in-person meetings or trainings; and/or represent Belong Health at events or volunteer activities. Medical and religious exemptions will be considered, and this policy will not supersede state or local laws.