Electronic Services Representative
Community Health Choice, Inc. (Community) is a non-profit managed care organization (MCO), licensed by the Texas Department of Insurance. Through its network of more than 10,000 providers and 94 hospitals, Community serves over 400,000 Members with the following programs:
• Medicaid State of Texas Access Reform (STAR) program for low-income children and pregnant women
• Children’s Health Insurance Program (CHIP) for the children of low-income parents, which includes CHIP Perinatal benefits for unborn children of pregnant women who do not qualify for Medicaid STAR
• Health Insurance Marketplace Plans that offer individual health coverage that includes preventive care, emergency services, prescription drugs, and hospitalization available to all, regardless of pre-existing conditions.
Improving Members' experiences is at the heart of every Community position. We strive every day to make sure that our Members have access to the high-quality health care they need and deserve.
Community is accredited by URAC for its health plan operations. We offer care management programs for asthma, diabetes, and high-risk pregnancy. An affiliate of the Harris Health System (Harris Health), Community is financially self-sufficient and receives no financial support from Harris Health or from Harris County taxpayers.
The Electronic Services Representative provides incoming and outgoing administrative support for the Customer Service Call Center to include intake, processing, routing and response to digital/electronic, and facsimiles communication. Completes timely documentation of requests and processing through the Managed Care Platform and data systems (QNXT & Salesforce). The E-service representative must possess content knowledge in (Medicaid/CHIP), Commercial, and Affordable Care Act products, analytical skills to quickly identify issues and resolve them within the desired timeframes. The E-service representative will be responsible for serving our customers in a multi-faceted work environment, to include, but not limited to communication via email, facsimiles, and chat. He or she will be completing customer requests to include, but not limited to primary care physician change, demographic updates, billing inquiries, and complex issues that include account research, reconciliation and the appropriate routing and resolution of member dissatisfaction and complaints. Maintain confidentiality of sensitive employee, customer and company data without exception.
Benefits and EEOC
Community employees’ benefits are provided by Harris Health. These benefits are designed to provide you with flexibility and choices in meeting your specific needs.
Community is an Equal Opportunity Employer.