About Us

Community Health Choice, Inc. (Community) is a non-profit managed care organization (MCO), licensed by the Texas Department of Insurance. Through its network of more than 10,000 providers and 94 hospitals, Community serves over 400,000 Members with the following programs:

• Medicaid State of Texas Access Reform (STAR) program for low-income children and pregnant women

• Children’s Health Insurance Program (CHIP) for the children of low-income parents, which includes CHIP Perinatal benefits for unborn children of pregnant women who do not qualify for Medicaid STAR

• Health Insurance Marketplace Plans that offer individual health coverage that includes preventive care, emergency services, prescription drugs, and hospitalization available to all, regardless of pre-existing conditions.

• Community Health Choice (HMO D-SNP), a Medicare Advantage Dual Special Needs plan for people with both Medicare and Medicaid that combines Medicare Part A and Part B benefits, Medicare Part D prescription drug coverage, and Medicaid benefits with additional health benefits like dental, vision, transportation, and more.

Improving Members' experiences is at the heart of every Community position. We strive every day to make sure that our Members have access to the high-quality health care they need and deserve.

Community is accredited by URAC for its health plan operations. We offer care management programs for asthma, diabetes, and high-risk pregnancy. An affiliate of the Harris Health System (Harris Health), Community is financially self-sufficient and receives no financial support from Harris Health or from Harris County taxpayers.

Job Profile

JOB SUMMARY: Responsible for accomplishing their primary goal of providing support and rendering Excellent Customer Service by addressing all Health Plan Member's calls related to inquiries, questions and concerns in all areas including enrollment, benefit interpretation and eligibility for medical care. Serving assistance to one/maximum two Lines of Business. Maintains confidentiality per HIPAA guidelines..

JOB SPECIFICATIONS AND CORE COMPETENCIES

Essential Functions
Call Handling: Answer and document Member's calls related to inquiries, questions and concerns in all areas including eligibility and status of claims and authorizations. Specifically, have the knowledge and acumen to accurately and concisely provide responses with the primary goal being that Excellent Customer Service is rendered in every connection with our Members.
Customer Service: Offer Excellent Customer Service through daily phone interaction with Members which is captured during Quality Monitoring.
Maintains a professional behavior and exhibit excellent interpersonal skills.
Marginal Functions
Other Duties as assigned

Reports to Position Title: Customer Svc Center Supervisor
Employees Supervised Titles: N/A

MINIMUM QUALIFICATIONS:
Education/Specialized Training/Licensure: High School Diploma or GED equivalent
Work Experience (Years and Area): 1-year Customer Service and/or Health Care / Plan experience in a call center or in a face to face setting.

Management Experience (Years and Area): N/A

Software Proficiencies: Microsoft Office (Word, Excel, Outlook)

Job Family/Job Title Competencies

The following competencies apply to this job family:

Select from the drop down below:

Analytical Thinking

Attention to Detail
Responding Sensitively

List any additional competencies not indicated above:
Bilingual (Spanish/Vietnamese) Preferred
Writing /Composing

Benefits and EEOC

Community employees’ benefits are provided by Harris Health. These benefits are designed to provide you with flexibility and choices in meeting your specific needs.

Community is an Equal Opportunity Employer.

Harris Health System's benefits program is designed to provide you with more flexibility and choices in meeting your specific needs. Harris Health System's benefits program allows you to protect your income in case of illness, death and disability, and to help you save for retirement.

It is the policy of Harris Health System to provide equal opportunity for all applicants for employment regardless of political affiliation, race, color, national origin, age, sex, religious creed or disability. Applicants may request any reasonable accommodation(s) to participate in the application process.

Job Category

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