Customer Care Associate
Roseburg, Oregon
Engagement & Relations – Customer Care /
Full-Time-Nonexempt /
On-site
At Umpqua Health, we're more than just a healthcare organization; we're a community-driven Coordinated Care Organization (CCO) committed to improving the health and well-being of individuals and families throughout our region. Our comprehensive services include primary care, specialty care, behavioral health services, and care coordination to ensure our members receive holistic, integrated healthcare. Our collaborative approach fosters a supportive environment where every team member plays a vital role in our mission to provide accessible, high-quality healthcare services. From preventative care to managing chronic conditions, we're dedicated to empowering healthier lives and building a stronger, healthier community together.
Umpqua Health strongly encourages applications from candidates of color as well as veterans, aiming to foster a work environment that is linguistically and culturally diverse and inclusive. Please note that at this time, Umpqua Health does not offer visa sponsorship.
Your Impact:
- Assist with in-person, written, and telephonic member inquiries.
- May assist with outbound calls to members, which may include welcome and retention calls.
- Research, verify and resolve inquiries relating to Oregon Health Plan (OHP) or Medicare eligibility, benefit coverage, claims processing, and complaints with guidance from management.
- Assist members with Primary Care Provider (PCP) and dental assignments.
- Learn to collaborate with others inside and outside department to explain benefits not covered and provide information on community resources when appropriate.
- Work collaboratively with providers, Oregon Health Authority (OHA), or members to ensure effective customer service and the resolution of health plan problems (i.e., eligibility and system) as needed.
- Use Call Tracking system to document all activities from any mode of communication from members, providers and other customers.
- Maintain confidentiality for all members in accordance with UHA policies and Health Insurance Portability and Accountability Act (HIPAA) regulations.
- Coordinate mailing of member materials as needed.
- Treat all members with honesty, courtesy, dignity, and respect.
- Provide members with professional, timely and competent service.
- Provide proactive, value-added service by identifying and reporting system/technology issues.
- Essential department and organizational functions.
- Propose and implement process improvements.
- Meet deadlines for completion of workload.
- Maintain agreed upon work schedule.
- Demonstrate cooperation and teamwork.
- Provide cross-training on specific job responsibilities.
- Consistently meet or exceed Department and Company standards and expectations including but not limited to quality, production and attendance.
- Meet identified business goals that contribute to departmental goals
- Comply with organization’s internal policies and procedures, Code of Conduct, Compliance Plan, along with applicable Federal, State, and local regulations.
- Maintain a general understanding of the grievances and appeals process according to company policies.
- Keep resource information up to date, accurate and organized.
Your Credentials:
- High school diploma or equivalent.
- 0-4 years of experience in customer service.
- Ability to learn and apply Oregon Administrative Rules (OARs), Federal laws and other regulatory agencies that relate to the medical health insurance industry.
- Strong customer service skills, including the ability to interact professionally, patiently, and courteously with members over the phone and in person.
- No suspension/exclusion/debarment from participation in federal health care programs (eg. Medicare/Medicaid).
Umpqua Health is an equal opportunity employer that embraces individuals from all backgrounds. We prohibit discrimination and harassment of any kind, ensuring that all employment decisions are based on qualifications, merit, and the needs of the business. Our dedication to fairness and equality extends to all aspects of employment, including hiring, training, promotion, and compensation, without regard to race, color, religion, gender, gender identity or expression, sexual orientation, national origin, genetics, disability, age, veteran status, or any other protected category under federal, state, or local law.
