Detroit Wayne Integrated Health Network

Customer Support

• Under the general supervision of the Customer Service Administrator, the Customer Service Representative is responsible for assuring that the Network’s Customer Service functions are carried out in accordance with all state and federal regulations and contractual requirements regarding Customer Service.
• Provides applicable Customer Service information, referrals, linkages, and follow-up for telephone, email, and walk-in inquiries.
• Facilitates inquiries regarding behavioral health, substance use disorders, dual eligibility, choice opportunities, family subsidy, etc.
• Provides systems navigation services such as the DWIHN website and Mental Health Wellness Information Network (MHWIN).
• Provide clarification of Explanation of Benefits (EOBs) to those enrollees who were in receipt of services, and answer enrollee claim status inquiries.
• Facilitates problem identification, clarification, and resolution assistance.
• Documents and refer to applicable inquiries regarding complaints, grievances, appeals, and dispute resolutions for appropriate follow-up.
• Provides direction, information, and educational materials to intended beneficiaries regarding enrollee rights and responsibilities.
• Provides and promotes self-advocacy, community inclusion, and peer support resource referrals.
• Provide support to enrollees and providers as needed.
• Assists with monitoring customer satisfaction.
• Conducts and participates in Customer Service phone and written surveys.
• Participates in the Customer Service data gathering applicable to the Customer Service Unit.
• Assists with the facilitation of planned training events.
• Assists with community and enrollee outreach activities.
• Interacts with contracted and non-contracted community agencies.
• Participates in Customer Service quality improvement activities, i.e., Mystery Shopping.
• Attend applicable network-related meetings and training as necessary. Performs related duties as assigned.