Customer Care Associate

Umpqua Health is a Coordinated Care Organization (CCO) in Roseburg, Oregon that serves over 30,000 OHP members within Douglas County, offering benefits, programs and outreach for those in need. Currently we are seeking a Customer Care Associate, to join our team.

• Full-time 40 hour per week - on-site position
• Generous benefit package including; PTO, Health Insurance, 401k with a company match, gym membership reimbursement and more.
• Hourly rate dependent upon experience.

The Customer Care Associate is the initial point of contact for members of Umpqua Health Alliance (UHA) and provides excellent customer service delivery relating to the services administered. This entry level position typically focuses on member inquiries but may assist with outbound calls.

ESSENTIAL JOB RESPONSIBILITIES

• Assist with in-person, written, and telephonic member inquiries.
• May assist with outbound calls to members, which may include welcome and retention calls.
• Research, verify and resolve inquiries relating to Oregon Health Plan (OHP) or Medicare eligibility, benefit coverage, claims processing, and complaints with guidance from management.
• Assist members with Primary Care Provider (PCP) and dental assignments.
• Learn to collaborate with others inside and outside department to explain benefits not covered and provide information on community resources when appropriate.
• Work collaboratively with providers, Oregon Health Authority (OHA), or members to ensure effective customer service and the resolution of health plan problems (i.e., eligibility and system) as needed.
• Use Call Tracking system to document all activities from any mode of communication from members, providers and other customers.
• Maintain confidentiality for all members in accordance with UHA policies and Health Insurance Portability and Accountability Act (HIPAA) regulations.
• Coordinate mailing of member materials as needed.
• Treat all members with honesty, courtesy, dignity, and respect.
• Provide members with professional, timely and competent service.
• Provide proactive, value-added service by identifying and reporting system/technology issues.
• Essential department and organizational functions.
• Propose and implement process improvements.
• Meet deadlines for completion of workload.
• Maintain agreed upon work schedule.
• Demonstrate cooperation and teamwork.
• Provide cross-training on specific job responsibilities.
• Consistently meet or exceed Department and Company standards and expectations including but not limited to quality, production and attendance.
• Meet identified business goals that contribute to departmental goals
• Comply with organization's internal policies and procedures, Code of Conduct, Compliance Plan, along with applicable Federal, State, and local regulations.
• Maintain a general understanding of the grievances and appeals process according to company policies.
• Keep resource information up to date, accurate and organized.

QUALIFICATIONS

Minimum Qualifications

• High school diploma or equivalent.
• Ability to learn and apply Oregon Administrative Rules (OARs), Federal laws and other regulatory agencies that relate to the medical health insurance industry.
• Strong customer service skills, including the ability to interact professionally, patiently, and courteously with members over the phone and in person.
• Strong computer application skills including MS Windows, Word, Excel and Outlook; comfort navigating through multiple documents and internet browsers.
• Strong active-listening skills.
• Strong written and verbal communication skills.
• The ability to articulate complex issues in an easy-to-understand manner.
• Ability to integrate rapidly with an existing team and to share ideas.
• Ability to proactively learn department processes.
• Ability to commit to improving quality and productivity.
• Ability to participate fully and constructively in department meetings.
• Ability to work in a fast-paced environment and manage multiple tasks.
• Research, analytical and sound problem-solving skills.
• Ability to adhere to a set schedule and demonstrate excellent attendance.
• Ability to work in an environment with diverse individuals and groups.
• May require the ability to meet criteria of the UHA Telecommuting Guidelines.
• Ability to respond to business needs flexibly, which may include overtime or flexible hours, weekends, and/or holidays.
• Ability to focus on and comprehend information, learn new skills and abilities, assess a situation and seek or determine appropriate resolution; ability to accept managerial direction and feedback and tolerate and manage stress.
• No suspension/exclusion/debarment from participation in federal health care programs (eg. Medicare/Medicaid).

Preferred Qualifications

• Experience in customer service or health care.
• Fluency through language testing in a second language relevant to the population served (Spanish).
• Strong written and verbal communication skills, in multiple languages.
• Experience considering the impacts of the work on multiple communities, including communities of color, in technical analysis.
• Experience working with different communication styles.

For more information or to apply visit our website at www.umpquahealthcareers.com

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