CALL CENTER REPRESENTATIVE-RI - HMSHost : Job Details

Great companies need great teams to propel their operations. Join the group that solves business challenges and enhances the way we work and grow. Working at Gainwell carries its rewards. You'll have an incredible opportunity to grow your career in a company that values your contributions and puts a premium on work flexibility, learning, and career development.

Summary

Customer service professional responsible for answering claims and eligibility-related questions from physicians, hospitals, and other medical providers that participate in Rhode Island Medicaid. Some self-research for policy-related requirements using Medicaid-provided resources and the Medicaid website for your learning as well.

Responsible for follow-up and call resolution including callbacks and closing call references.

Excellent verbal communication skills are required along with asking fact-finding questions. Reference material is available for your call support allowing for excellent customer service with solid responses. Follow up required with providers as necessary. Detailed notes are needed for call references.

Additionally, providing updates to members on Benefit Plan Choice Selection and Premium payment status on the Adult Managed Care line.

Answering customer inquiries to ensure processing is in accordance to billing procedures. Follow up with supervisor on more complex, non-routine customer inquiries, including member requests and concerns.

Previous medical or medical billing experience is a plus, but not necessary.

Your role in our mission

This is an important position it provides knowledgeable responses to basic client questions; and elevates more complex cases to appropriate staff as needed.

* Answer an estimated 40-50 inbound calls daily from the Rhode Island Medicaid provider network and member beneficiaries. Providing excellent oral communications with quality customer service. Follow through and resolve all calls.

* Address billing and eligibility questions with your commitment to follow up as necessary to resolve.

* Create and manage computer call logs/references for added review and follow up with solid outcomes.

* Provide excellent customer service to include offering added assistance as appropriate. This includes becoming familiar with web service offerings to support and direct a provider to these offerings.

* Train and support peers and new team members

* Offline work

* Quality Control of provider Enrollment for all aspects of enrollment entries

* Claim Resolutions completed weekly sent by Claims Supervisor

What we're looking for

* Minimum of a high school diploma or GED.

* Previous customer service experience in a professional setting.

* Two years or more of customer service experience, either face-to-face or by phone.

* Detail oriented

* Prompt and reliable

* Good typing and computer skills

* Excellent verbal communication and Customer Service skills

What you should expect in this role

* Hybrid

* The hours are full-time, Mon-Friday - 8:30-5:00 - hybrid in Warwick RI

* Candidate must be local and willing to come to the office every day for the first month or so of training. Once trained they will be in the office 2 days a week.

The pay range for this position is $29,100.00 - $41,600.00 per year, however, the base pay offered may vary depending on geographic region, internal equity, job-related knowledge, skills, and experience among other factors. Put your passion to work at Gainwell. You'll have the opportunity to grow your career in a company that values work flexibility, learning, and career development. All salaried, full-time candidates are eligible for our generous, flexible vacation policy, a 401(k) employer match, comprehensive health benefits, and educational assistance. We also have a variety of leadership and technical development academies to help build your skills and capabilities.

We believe nothing is impossible when you bring together people who care deeply about making healthcare work better for everyone. Build your career with Gainwell, an industry leader. You'll be joining a company where collaboration, innovation, and inclusion fuel our growth. Learn more about Gainwell at our company website and visit our Careers site for all available job role openings.

Gainwell Technologies is committed to a diverse, equitable, and inclusive workplace. We are proud to be an Equal Opportunity Employer, where all qualified applicants will receive consideration for employment without regard to race, religion, color, national origin, gender (including pregnancy, childbirth, or related medical condition), sexual orientation, gender identity, gender expression, age, status as a protected veteran, status as an individual with a disability, or other applicable legally protected characteristics. We celebrate diversity and are dedicated to creating an inclusive environment for all employees.