The Office of Management and Enterprise Services (OMES) is a trusted, credible partner that empowers employees to provide valued business expertise allowing customers to focus on their missions across state government. OMES provides financial, property, purchasing, human resources and information technology services to all state agencies, and assists the Governor’s Office on budgetary policy matters.
Our mission is supporting our partners through unified business services. The OMES mission requires a highly-qualified workforce committed to making government run in the most efficient, innovative manner possible. Achieving that mission takes team-oriented, solutions-driven professionals who understand the importance of partnering to achieve success.
OMES is seeking a full-time Call Center Specialist. This is an unclassified position in state government located in Oklahoma City, OK. OMES offers a comprehensive Benefits Package, including a generous benefit allowance to offset the cost of insurance premiums for employees and their eligible dependents. For more information about the benefit allowance [click here].The annual salary for this position is up to $42,850, based on education and experience.
This position is responsible for answering calls and providing customer service for participants of the HealthChoice benefit plans. This includes interpreting the plans process related to benefits/eligibility, third party administrators, enrollment, change, termination, retirement, Medicare, premiums, COBRA, life insurance benefits, pharmacy benefits. The Call Center must support the HealthChoice programs and special interactive programs such as HelpCheck incentives, HRA tool and Option Period activity for all plans offered when the call requires.
• Answer calls in the call center loop from members, providers and insurance coordinators, interpreting the plans processes related to eligibility, enrollment, change, termination, retirement and COBRA by providing oral responses to queue generated calls or direct calls to active members, dependents, retired members, and survivors based on knowledge of rules, regulations, statutes and understand details of Centers of Medicare and Medicaid Services (CMS) guidelines as a contracted CMS provider as well as work processes or procedures that may apply.
• Execute or respond to all paper, email or RightNow system communication in a timely manner, whether communication is from a member, supervisor, manager, peer or other source.
• Maintain a complete and accurate log of each call taken or placed, each fax received or sent, and each email or paper correspondence received or assigned by Management.
• Assist members by coordinating with other departments in claim, pharmacy, eligibility, premium billing or payment and/or policy issue resolution by researching and working in partnership with departments to resolve benefit concerns and ensure member satisfaction.
• Troubleshoot health, dental benefits or pharmacy purchase denials or Prior Authorizations when an issue arises for member, provider, or pharmacy.
• Mail or fax requested plan information.
• Assist in training new employees on all Call Center activity and materials when needed and provide immediate guidance to peers in response to call inquiries.
• Review articles, manuals, publications for improving various public information/communications as well as the HealthChoice website to guide the caller or member to various resources, troubleshoot password issues and contribute to web content based on reported member call trends.
• Interface with various computer programs to log, reply, write, review, copy, email, fax, scan, reference, update, comply with, or create various records.
• HIPAA Compliance - Must safeguard all Personal Health Information (PHI) by making sure work area is HIPAA compliant and all work stations are secure while away.
A bachelor’s degree in business administration, public health administration or a related field, or four (4) years of experience in health, dental, life and disability customer service environment; or an equivalent combination of education and experience.
Valued Skills and Experience
• Must comply with all agency, state and federal HIPAA and Fraud, Waste and Abuse policies
• Knowledge of state and federal laws and regulations pertaining to various types of health, dental, vision, life, disability, flexible benefits and federally mandated programs, including CMS-Medicare guidelines.
• Knowledge of medical dental and insurance terminology.
• Knowledge of insurance plan related administrative procedures.
• Knowledge of employee benefits for state, education and local government employees.
• Knowledge of Microsoft Office and additional functional programs or software.
• Ability to establish and maintain effective working relationships with others.
• Ability to communicate effectively, both orally and in writing.
• Ability to exercise good judgment in analyzing situations and making decisions.
OMES is an Equal Opportunity Employer. Reasonable accommodation to individuals with disabilities may be provided upon request.