Minimum Qualifications

Education: High School Diploma or GED; some college preferred

Licenses/Certifications: (None)

Experience / Knowledge / Skills:

• Three (3) years Customer Service or Claims processing experience in a TPA or HMO environment
• Bilingual preferred

• Demonstrates commitment to the Partners-in-Caring process by integrating our culture in all internal and external customer interactions; delivers on our brand promise of "we advance health" through innovation, accountability, empowerment, collaboration, compassion and results while ensuring one Memorial Hermann.

Principal  Accountabilities

• Efficiently and courteously responds to telephone inquiries from subscribers regarding benefit verification, claims issues, and eligibility.
• Interprets plan coverage for subscribers and providers to determine correct level of benefit coverage.
• Provides claim filing instructions when needed to subscribers and providers.
• Provides telephone assistance to subscribers and providers, and verifies eligibility as required.
• Promptly returns phone calls resulting from inquiries that require additional research.
• Efficiently enters data simultaneously while listening attentively.
• Provides a high degree of confidentiality/discretion and independent judgment.
• Keeps workstations stocked and organized at all times.
• Performs daily clerical duties, including sending faxes, making copies, and assisting in other areas.
• Efficiently makes requested changes (temporary address changes, ID card requests).

• Ensures safe care to patients, staff and visitors, adheres to all Memorial Hermann policies, procedures, and standards within budgetary specifications including time management, supply management, productivity and quality of service.

• Promotes individual professional growth and development by meeting requirements for mandatory/continuing education, skills competency, supports department-based goals which contribute to the success of the organization; serves as preceptor, mentor, and resource to less experienced staff.

• Other duties as assigned.