Innova Care Health, Inc. is a leading provider of managed healthcare services in North America. Through two primary avenues of care, Provider Networks and Medicare Advantage, they are committed to quality healthcare by creating models that are cost-effective and fully integrated with advanced technologies.
The company is a leading Medicare Advantage organization providing healthcare-related services in Puerto Rico since 2001 and most recently entering the Medicaid market as well.
This organization operates a medical service organization, which coordinates care through a network of 27 independent physician associations and over 2,900 primary care physicians.
Additionally, it operates two Medicare Advantage plans, the Island’s only NCQA-accredited health plans, which serve 200,000 members on the Island with a network of more than 7,500 providers.
MMM of Florida, an affiliate of the Company “and subsidiary of Innova Care” is seeking qualified Customer Service Representatives with extensive experience in the area of managed care / health plan setting for their new start-up operations in the Miami Dade, Broward and Palm Beach counties.
This position is responsible to serve as a primary liaison between enrolled Medicare beneficiaries and MMM of Florida for the purposes of member and provider education, issues resolution, and customer satisfaction.
Essential Duties and Responsibilities:
- Employee will be trained in different skills, in order to support departmental initiatives with staffing needs.
- Employee will be assigned to support inbound and outbound contacts. Support may include but not limited to: Part C Members calls, Pharmacy Member calls, and outbound Campaigns.
- Assures coverage of Customer Service contacts during operating hours.
- Register member and provider contact in system as applies.
- Accomplish established metrics by the Contact Center Management on a daily, weekly and monthly basis.
- Forwards performs and/or processes orientations regarding disenrollment, cancellations, reimbursements, outbound calls, Member satisfaction surveys, etc.
- Maintain itself in continuous learning environment with updated information obtained in trainings, emails, one on one’s, staff meeting and any other way.
- Manage CTI system in a daily basis.
- Report any unusual situation identified at the time of the member and/or provider contact.
- Manage and identify CMS calls.
- Manage contacts requesting interpreter services for foreign languages.
- Special projects as assigned.
Education and Experience:
Associate degree in health, business related field or comparable experience. Have a minimum of 2 years experience in healthcare and/or Contact Center environment. Health plan customer service experience and a license as an insurance agent, service representative, customer representative, or limited customer representative preferred. Good communication, interpersonal and problem-solving skills.
General Abilities and Knowledge:
- Computer literate, preferably in the following applications: Word, Excel and Outlook. Ability to respond to a high volume of work and maintain a polite and professional manner at all times.
- Able to function with frequent interruptions.
- Ability to prioritize workloads for maximum efficiency.
- Customer Service Skills: practicing, valuing and supporting service to both internal and external customers.
- Time Management Skills: establishing priorities and accomplishing tasks in a timely manner.
- Team Work: ability to work in a team environment to create solutions to problems.
- Have strong interpersonal skills.
- Excellent verbal and written communication skills.
- English and Spanish literate.
Ability to read and comprehend simple instructions, short correspondence, and memos. Ability to write simple correspondence. Ability to effectively present information in one-on-one and small group situations to customers.
Ability to add, subtract, multiply, and divide in all units of measure, using whole numbers, common fractions, and decimals.
Ability to apply common sense understanding to carry out instructions furnished in written or oral form, detailed but not complicated. Ability to deal with problems involving few concrete variables in standardized situations.
Physical and Mental Demands:
- Position requires sitting and standing associated with a normal call center environment. Regularly talks and hears.
- This position requires that weight be lifted or force be exerted up to 10 pounds.
Environmental and Working Conditions:
Working on normal call center environment is required. The noise is typically moderate. Evening or weekend work, as necessary. Working flexible work hours; depending operational needs.
This description is intended to provide only basic guidelines for meeting job requirements. Responsibilities, knowledge, skills, abilities and working conditions may change as needs evolve.
- Call center: 2+ years (Preferred)
- Customer Service: 2+ years (Preferred)