Sr. Call Center Representative

Date Posted: Jan 30
Type: Contract
Wage: 20-25/hr
Job Number: 7017
Location: Houston, TX

TITLE: Call Center Representative
CLIENT: Hospital
TYPE: 3 month Contract
RATE: 25/hr depending on experience

Currently seeking 4 Call Center Representatives with former hospital or claims processing experience for our enterprise sized client in the medical field on a 3 month contract due to increased workload.


• To serve as a Member and/or Provider Advocate by possessing knowledge and understanding of the organization's processes, policies and procedures in order to investigate, resolve and/or facilitate resolution of simple to moderately complex issues and/or questions reported by hospital Health Plan members, prospective members, healthcare providers, or other entities relating to Health Plan Managed Care Organization.
• To be the first point of contact for assistance or information
regarding eligibility, benefits, authorizations, claims, referrals and/or any other Member/Provider needs.
• To assist and advocate for Members and/or Providers throughout the complaint and appeal process.
• To assist Members with timely appointment scheduling.


• Verifies member eligibility and provides support for this activity for the Call Center Representatives, as
• Acts as a secondary resource to Call Center Representatives in the absence of the Team Lead. Responds to escalated calls
as appropriate and triages to Management, if necessary.
• Assists with processing workflow queues i.e., urgent requests to ensure timely submittal as requested by the Team Lead.
• Assists with onboarding of new hire employees after training in a Nesting environment. Provides the opportunity for job
shadowing and mentorship.
• Completes and manages Pharmacy queue / Right Fax.


** Must have Customer service experience within managed care or insurance industry Or Call center experience within any industry

• Knowledge of managed care, Medicaid, call center desktop support applications, customer relations techniques and
general computer literacy.
• Benefits, claims processing or membership knowledge is preferred.
• The ability to work well with the public and adopt a customer perspective and work well individually and in a team
• Effective interpersonal skills and phone etiquette are required
• Strong verbal communication skills
• Good listening skills
• Knowledge of medical terminology
• Problem identification and problem solving skills and able to multitask

• Bilingual (English-Spanish) preferred


H.S. Diploma or GED- Required

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