Customer Care Representative

🔥 0 minutes ago

🇺🇸 United States – Remote

💵 $28 - $39 / hour

⏱ Part Time

🟢 Junior

💝 Customer Support

🚫👨‍🎓 No degree required

👻 Ghost score 0%

What it means: how likely this posting is sitting open without active hiring.How to read it: 60% or higher means we think this is a ghost. Lower scores are less of a worry.How we score it: age, reposts, open roles vs team size, how fast jobs close, and whether pay is listed.Fine print: an estimate from public data, not a judgment of the company. Real jobs can score high, so treat it as a hint, not a fact.

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Sharp HealthCare

WebsiteLinkedInAll Job Openings

10,000+ employees

Founded 1946

🏥 Healthcare

🧘 Wellness

Healthcare • Nursing • Wellness

Sharp HealthCare is a healthcare organization dedicated to providing high-quality medical services to patients and families. With a commitment to innovation, safety, and excellence, Sharp HealthCare offers a range of career opportunities in nursing, clinical support, administration, and various medical specialties. The organization emphasizes a collaborative work environment and is recognized for its nursing excellence, aiming to advance the science of medicine alongside compassionate patient care.

📋 Description

• Responsible for direct and timely communication between the Plan and Plan members, potential members, providers, employer groups, brokers, internal departments and external agencies • Maintain high-level knowledge of Plan products, premiums, benefits and procedures • Select appropriate resources to assist callers and provide information on Plan products, premiums, benefits, policies and procedures • Accurately solve problems, research concerns, and resolve issues • Access patient data and document all calls in the IDX Customer Service Module • Verify prescription drug eligibility, benefits, claims, and authorizations in PBM's MedAccess system • Add and update member information in MedAccess • Maintain knowledge of IDX modules for Registration, Enrollment, Claims, Utilization Management and Premium Billing • Verify enrollment, benefits, premiums and other information in Salesforce • Generate member letters using Globalworks and retrieve documents from OnBase • Use SharpConnect to assist members with online inquiries • Resolve Commercial member inquiries and complaints by phone • Provide prompt, accurate service to internal and external customers • Collaborate with Plan, medical group, health services, enrollment, claims, underwriting, providers, office staff, vendors, employers and brokers • Assist members in understanding health coverage, enrollment materials, Plan services and provider networks • Answer eligibility, enrollment, PCP assignment, benefits, referrals, ID cards, premiums, subsidies, COBRA and Cal-COBRA inquiries • Document concerns, complaints and appeals and forward them to the appropriate Customer Care Lead or Supervisor • Process ACH and credit card payments over the phone • Recommend appropriate Sharp Health Plan options to prospective purchasers • Identify and recommend solutions for operational problems • Comply with DMHC, CMS and NCQA customer service requirements and timelines • Participate in special projects including member orientation, billing reminders, education, claims investigation, pharmacy authorizations, appeals and reimbursement requests

🎯 Requirements

• H.S. Diploma or Equivalent • Minimum of six (6) months experience as a Customer Call Center Representative • Medical office certification, to include medical terminology, preferred • Associate's Degree Business administration or health care administration, preferred • Customer service or medical office experience, preferred • Experience working full time as SHP Customer Care Temporary CCR I, preferred • Bilingual preferred but not required • Basic computer and writing skills • Demonstrated knowledge of Plan benefits, policies and procedures • Knowledge of current matters relating to health maintenance organizations, performance management, and customer satisfaction assessment and delivery • Superior interpersonal skills • Mature and sound judgment in the commitment of the plan's mission and operating goals • Ability to effectively participate in the activities of the Customer Care area