Customer Service Representative
Detroit Wayne Integrated Health Network
full-time
Posted on:
Location Type: Hybrid
Location: Detroit • Missouri • United States
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Salary
💰 $60,248 - $75,159 per year
About the role
- 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.
Requirements
- A bachelor’s degree from a recognized college or university in Human Service, Social Service, Public Health, Public Administration, Healthcare Administration, Health Management, Business Administration, Conflict Resolution, Criminal Justice, Psychology, Counseling, Social Work, or a related field.
- Five (5) years of full-time paid experience performing duties and responsibilities in the following areas:
- Experience working in a customer service environment in a mental health setting
- Experience working with complaints, grievances, and appeals.
- Experience working with enrollees, training, peer counseling, and advocacy.
- OR Experience working with the State mental health regulatory requirements.
- Education in Human Service, Social Service, Business Administration, Criminal Justice, or a related field may be substituted on a year-for-year basis for required experience.
Benefits
- Proof of being fully vaccinated for COVID-19 as a condition of employment
Applicant Tracking System Keywords
Tip: use these terms in your resume and cover letter to boost ATS matches.
Hard Skills & Tools
customer servicesystems navigationdata gatheringproblem identificationconflict resolutionpeer counselingadvocacytraining facilitationquality improvementmental health regulatory requirements
Soft Skills
communicationinterpersonal skillsorganizational skillscommunity inclusionself-advocacycustomer satisfaction monitoringoutreachcollaborationproblem-solvingeducational material provision