Customer Experience Specialist I (REMOTE) SWHR CNC

Customer Experience Specialist I (REMOTE)

Southwestern Health Resources, a national leader in population health, is looking for a qualified Customer Experience Specialist I to join our Care N' Care 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.

Position Highlights

• Work location: This position is a Remote/Work from Home opportunity
• Work environment: Care N' Care
• Work hours: Full-time, 40 hours weekly, Rotating Shifts
  
  • April 1 - September 30, 8 am - 8 pm (CST), Monday through Friday and
  • October 1 - March 31, 8 am - 8 pm, (CST), Sunday through Saturday, seven days a week
• Travel: Local travel to attend on-site meetings or as requested to the SWHR Corporate Headquarters located at 1603 LBJ Freeway, Farmers Branch, Texas 75234
• Please note: The Customer Experience Specialist I is employed by SWHR. SWHR is a clinically integrated network formed by Texas Health and UT Southwestern.
• Salary range: $16.18 - $24.06 per hour (based on relevant experience)

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 and UT Southwestern, two of the region's leading healthcare systems, SWHR delivers nationally preeminent, highest-quality care in 16 counties across North Texas. SWHR is also the parent organization of Care N' Care Insurance Co., a regional Medicare Advantage Plan serving more than 13,500 members in the region.

The SWHR network includes physicians from UT Southwestern and Texas Health, and independent community primary care and specialty physicians. In partnership, our team implements physician-driven, value-based care strategies to coordinate care for more than 700,000 patients, resulting in lower costs and high-quality care. In 2020, the Centers for Medicare & Medicaid Services released the annual financial and quality results and, based on the report, SWHR is one of the nation's leading Next Generation Accountable Care Organizations, having saved nearly $120 million since joining the program in 2017.

Qualifications

• High School Diploma or equivalent (required)
• Bachelor's Degree (preferred)
• 2 Years Customer Service, Sales or Account Management experience in Medicare, Medicare Advantage, or other applicable Health Plan experience and be comfortable and familiar with PPO's and HMO's, Employer Group, and potentially Commercial insurance (preferred)
• 2 Years Multi-functional High-Volume Customer Interaction handling experience (preferred)

Position Responsibilities SWHR Customer Experience Specialist I provides 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.

In addition to the required qualifications, a successful Customer Experience Specialist I will:

• broad understanding of financial and accounting principles.
• 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 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

Why Southwestern Health Resources
As a Southwestern Health Resources 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.
Moving healthcare forward
At the heart of SWHR are people who help people. We care about those we serve and each other. To be the national leader in providing population-based healthcare, our more than 850 employees use their knowledge, data insights and clinical experience to deliver care to the right patient, at the right time and in the right setting. By connecting physicians to patients and clinical insights to better outcomes, SWHR lowers costs, optimizes value, and builds a better healthcare system for all.
We invite you to learn more about us at .
Let's move healthcare forward - together.

Highlights:

• Combining the strengths of UT Southwestern Medical Center, Texas Health Resources and more than 2,500 community physicians, we offer the largest provider network in North Texas. SWHR covers approximately 700,000 patient members across 16 counties in North Texas.
• 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.

Additional perks of being a SWHR Customer Experience Specialist I

• Gain a sense of accomplishment by contributing in a teamwork environment
• Positively impact patients' quality of life
• Receive excellent mentorship, comprehensive training and dedicated clinical 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 .

Additional Information

• Location: Dallas, Texas, United States
• Job Field: Clerical/Admin
• Shift: Day Job
• Schedule: Full-time
• Pay Basis: Hourly
• Minimum Salary: US Dollar (USD) 16.18
• Market Salary: US Dollar (USD): 19.71
• Maximum Salary : US Dollar (USD) 24.06