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Work Background
CareOregonCustomer Service Representative III
Jan. 2018 - Nov. 2024Portland, OregonGeneral Statement of Duties
The Customer Service Representative III is an initial point of contact for customers of CareOregon and provides all aspects of excellent customer service delivery relating to the Oregon Health Plan, Medicaid, Medicare, Group and Individual Medical, Dental and Mental Health. This senior level position focuses on member inquiries for all lines of business, as well as outbound calls and/or other projects and initiatives. Cognitive and Other Skills and Abilities
Ability to focus on and comprehend information, learn new skills and abilities, assess a situation and seek or determine appropriate resolution; ability to accept managerial direction and feedback and tolerate and manage stress. Education and/or Experience
Required:
▪ Minimum 2 years’ customer service experience required, including minimum 1 year in a health care customer service call center; experience should include meeting or exceededing quality and productivity metrics needed for this position for 3 consecutive months.
Preferred:
▪ Work experience utilizing bilingual skills Working Conditions
▪ Environment: This position’s primary responsibilities typically take place in the following environment(s) (check all that apply on a regular basis):
☒ Inside/office☐ Clinics/health facilities☐ Member homes
☐ Other_________________________________________
▪ Travel: This position may include occasional required or optional travel outside of the workplace, in which the employee’s personal vehicle, local transit, or other means of transportation may be used.
▪ Equipment: General office equipment
▪ Hazards: n/a
FamilyCare HealthNavigator II Medicare Port
Sep. 2010 - Nov. 2017825 NE Multnomah, Suite 1400, Portland, OR 97232Member Navigator’s positively interacts with members and co-workers to resolve eligibility/benefit issues. Status claims, authorizations, pharmacy inquiries and other health plan questions and concerns for Medicaid and Medicare members. Assist in primary care physician assignment, coordinating interpreter services, health intakes, member welcome calls, renewal calls and routing grievances/appeals in a professional and timely manner. • Focus on answering inbound calls for Medicaid and Medicare members, pharmacy related questions, appropriate and accurate primary care assignment/changes, demographic updates, member eligibility and benefits, retroactive adjustments and claim status.
• Assist in making outbound member welcome calls, Health Risk Assessment, various questionnaires/outreach and renewal and redetermination calls.
• Respond to calls from the teletypewriter line.
• Investigate and document thoroughly all call/issues to the point of resolution.
• Contact our pharmacy and vision vendors to verify or update member information.
• Complete requests from members and providers received through claim systems, voice mail, fax, paper and electronic mail.
• Issue forms, letters, and welcome/thank you cards and correspondence when appropriate.
• Process provider member disenrollment notifications. • Possess and uphold a high level of knowledge of all current benefit plans and operational procedures; communicate and understand this knowledge clearly.
• Work flexible hours as needed.
Banner BankCommercial Loan Processor
Feb. 2003 - Feb. 2008Lake Oswego, Oregon
U.S. BankCommercial Loan Processor
Mar. 1991 - May. 2002Portland, Oregon
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