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    Customer Experience Specialist I - Dallas, United States - Southwestern Health Resources

    Southwestern Health Resources
    Southwestern Health Resources Dallas, United States

    4 weeks ago

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    Description

    ** Customer Experience Specialist I - Care 'N Care**

    ****

    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.

    **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. **Why Southwestern Health Resources**

    As a Southwestern Health Resources youll 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. * 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 * Location: Dallas, Texas, United States

    Job Field: Clerical/Admin

    Shift: Day Job

    Schedule: Full-time

    Pay Basis: Hourly

    Minimum Salary: US Dollar (USD

    Market Salary: US Dollar (USD): 19.71

    Maximum Salary : US Dollar (USD) 24.06

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