The Requirements
To be a good fit for this opportunity you will have:- A high school diploma or GED; an associate's degree is preferred.
- One year of customer service and / or claims experience is strongly preferred.
- Bilingual skills in English and Vietnamese. You'll need to be able to perform all the responsibilities of this position in either English or the second language.
- Working knowledge of PC applications in a Windows-based environment.
- Healthcare or managed care experience is a plus.
- Minimum 45 wpm keyboarding skill preferred.
- Establish effective relationships, exhibit tact and consideration, and display a positive outlook and pleasant manner.
- Adhere to a stringent schedule (begin work on time, keep absences within guidelines, return on time from breaks and meals, display flexibility regarding scheduling and schedule time off in advance).
- Handle difficult customers effectively.
- Display a high level of initiative and an action orientation.
- Demonstrate effective listening skills.
- Leverage strong analytical and problem solving skills.
- Utilize a professional telephone speaking voice.
- Perform well and maintain composure under stress.
- Learn new skills, knowledge and systems quickly.
- Multi-task, prioritize work and manage time.
- Demonstrate effective oral and written communication skills.
The Role
You will join a large and diverse group that provides customer service for seven (and growing) health plans in the US. We'll look to you to respond in a timely, professional and courteous manner to all customer inquiries, including member and / or provider phone calls or correspondence regarding benefit, eligibility or customer issues. Your specific activities will include:- Servicing calls and correspondence from members and / or providers, and identifying and/or responding to inquiries, dissatisfaction, complaints and grievances. You'll document all calls in the inquiry tracking system; apply established protocols to ensure resolution is provided and presented in a clear and accurate manner; and facilitate problem resolution and act as a customer advocate.
- Researching member / provider and / or enrollment issues utilizing department procedures, reference materials and internal and external systems. This will include accurately updating member / provider information in all appropriate systems.
- Identifying member / provider issues and referring to appropriate departments. You will monitor inquiries forwarded to other departments and follow through to ensure timely resolution, follow up on outstanding inquiries and work with department staff to identify and resolve areas of non-compliance. In addition you'll distinguish between routine and significant issues and notify management of any issue that could negatively impact service.
- Reviewing phone activity and quality reports to self-monitor performance, quality and productivity standards. You'll discuss deficiencies / problems with the supervisor to adjust behavior and work activities as appropriate.
- Maintaining a balance of productivity, quality and timeliness of job accountabilities.
- Utilizing AT&T Language Line and the Telecommunications Digital Device (TDD) when necessary to service non-English speaking or hearing impaired members.
- Creating and supporting an environment that fosters teamwork, cooperation, respect and diversity.
Why AmeriHealth
Great location-- you'll work in our corporate headquarters, an attractive facility (pictured) right off of Route 291 and near I-95; parking is free. We're also near public transportation, including the SEPTA Airport line. Because we are outside of Philadelphia, you won't be subject to the city wage tax unless you reside in Philadelphia.Expansion through visionary leadership -- under the leadership of President and CEO Michael A. Rashid, AmeriHealth Mercy has embraced an ambitious strategy to build the reserves and infrastructure needed to achieve market leadership over the next five years. Rashid's vision: by 2015 AmeriHealth Mercy Family of Companies will be recognized as the national leader in developing health care solutions for the chronically ill and the underserved.
Doing it right-- you will find a strong sense of mission throughout AmeriHealth Mercy. We make money to serve the poor, while most of our competitors serve the poor to make money. Our people put a high value on the satisfaction they derive from helping improve the quality of life in our communities.
High quality, award winning products -- AmeriHealth Mercy offers quality health care products and services designed specifically to meet the changing health care needs and high expectations of our customers. For example, Keystone Mercy Health Plan, AmeriHealth Mercy Health Plan and Select Health of South Carolina all have received the highest possible accreditation by the national leader in HMO quality evaluation. The National Committee for Quality Assurance has awarded these HMOs "Excellent" status for meeting its rigorous evaluation standards.
Excellent benefits -- in addition to a competitive wage, we offer comprehensive benefits that include all you would expect as well as some pleasant surprises, such as health insurance that starts the first of the month after you start, a pension and 401(k) plan, generous holidays and paid time off and more.
Keys to Success
This is an excellent opportunity if you flourish in a structured environment and take pride in being reliable and professional. If you are the person we're looking for, you understand the importance of performing to productivity and quality standards. To thrive here you will learn quickly and be motivated to improve on a continual basis. We'll also look to you to remain flexible as priorities and needs change. In addition, you'll need to share our commitment to our mission: we help people get care, stay well and build communities; we have a special concern for those who are poor.In addition we'll look to you to:
- Establish and maintain positive communication and professional demeanor with other employees and clients at all times.
- Adhere to organizational policies and procedures, as well as support and carry out the Mercy Mission and Values.
- Demonstrate and support commitment to corporate goals and mission.
About AmeriHealth
The AmeriHealth Mercy Family of Companies (AMFC) is one of the nation's leaders in health care solutions for the underserved. AMFC operates in 12 states and serves more than four million Medicaid, Medicare and SCHIP members through its Medicaid managed care products, pharmaceutical benefit management services, behavioral health services and other administrative services. Headquartered in Philadelphia, AMFC is a mission-driven company with nearly 30 years of experience serving low-income and chronically ill populations. AMFC's core products include full-risk HMOs, management contracts, administrative services, pharmacy benefit management, care management services and behavioral health care management services.AMFC owns and operates four full-risk Medicaid managed care plans: AmeriHealth Mercy Health Plan (Harrisburg, PA); Keystone Mercy Health Plan (Philadelphia, PA); LaCare (Baton Rouge, LA); and Select Health, Inc. (Charleston, SC). Our extensive experience with Medicaid TANF and SSI populations makes us a leader in voluntary and mandatory Medicaid markets.
Our service is built on these values:
- Advocacy
- Care of the Poor
- Compassion
- Competence
- Dignity
- Diversity
- Hospitality
- Stewardship