Customer Service Specialist

Dallas, TX, United States

Qlarant is a not-for-profit corporation that partners with public and private sectors to create high quality, safe, and efficient delivery of health care and human services programs. We have multiple lines of business including population health, utilization review, managed care organization quality review, and quality assurance for programs serving individuals with developmental disabilities. Qlarant is also a national leader in fighting fraud, waste and abuse for large organizations across the country. In addition, our Foundation provides grant opportunities to those with programs for under-served communities.

Are you looking for an opportunity to combine your excellent customer service, communication and research skills with your knowledge of healthcare? Do you approach your work with a strong sense of urgency and thrive in fast-paced environments? If this describes you, Qlarant has the perfect career opportunity!

We have an immediate opening for a Customer Service Specialist in our Dallas office located just north of the Galleria Dallas. As a member of our Investigations MEDIC team, this position performs clerical/administrative duties related to reports of potential fraud, waste and abuse from Medicare Part C&D beneficiaries. Please note: This position has a starting wage of up to $17.35/hour plus career advancement opportunities, an inclusive work environment and an excellent benefits package with health insurance, two retirement plans, and generous vacation and sick leave accruals.

Essential Duties and Responsibilities:

Communicates with beneficiaries, plans, pharmacies, and providers as needed to resolve complaints.

Provides information to investigative and medical staff.

Evaluates the facts of a complaint and researches additional information as necessary.

Compiles findings and determines if appropriate for presentation to triage team.

Assists in preparing weekly and monthly reports of all customer service activities.

Handling a wide variety of complex and confidential situations.

Performs data entry of complaints into the case management system and a variety of other databases.

Performs background research on subjects of interest as required for the screening of complaints for triage.

Drafts and writes correspondence using appropriate letter templates or revises the content based on the facts presented in the complaint.

May communicate with external customers including beneficiary or individual complainants, representatives from the Senior Medicare Patrol, Plan Sponsors, CMS and others.

Required Skills

To perform the job successfully, an individual should demonstrate the following competencies:

Analytical - Collects and researches data; Uses experience to complement data.

Problem Solving - Identifies and resolves problems in a timely manner; Gathers and analyzes information skillfully; Develops alternative solutions; Works well in group problem solving situations; Uses reason even when dealing with emotional topics.

Oral Communication - Speaks clearly and persuasively in positive or negative situations; Listens and gets clarification; Responds well to questions; Demonstrates group presentation skills; Participates in meetings.

Written Communication - Writes clearly and informatively; Edits work for spelling and grammar; Varies writing style to meet needs; Presents numerical data effectively; Able to read and interpret written information.

Teamwork - Balances team and individual responsibilities; Exhibits objectivity and openness to others' views; Gives and welcomes feedback; Contributes to building a positive team spirit; Puts success of team above own interests; Able to build morale and group commitments to goals and objectives; Supports everyone's efforts to succeed.

Customer Service - Manages difficult or emotional customer situations; Responds promptly to customer needs; Solicits customer feedback to improve service; Responds to requests for service and assistance; Meets commitments.

Judgment - Displays willingness to make decisions; Exhibits sound and accurate judgment; Supports and explains reasoning for decisions.

Professionalism - Approaches others in a tactful manner; Reacts well under pressure; Treats others with respect and consideration regardless of their status or position; Accepts responsibility for own actions; Follows through on commitments.

Other Skills and Abilities:

Ability to work with highly sensitive information while preserving the confidentiality of the information

Working understanding of Medicare (Part C or Part D preferred), medical terminology, medical coding background is preferred.

Intermediate level Microsoft Office skills to include Word, Excel and Outlook.

Required Experience

High school diploma or general education degree (GED) required.

At least one year of experience in a clerical/administrative, customer service or call center related role or an equivalent combination of education and experience.

Intermediate level Microsoft Office skills to include Word, Excel and Outlook required.

Working understanding of Medicare (Part C or Part D preferred), medical terminology, and/or medical coding background is preferred.

Qlarant is an Equal Opportunity Employer of Minorities, Females, Protected Veterans, and Individuals with Disabilities.

Qualifications:

To perform the job successfully, an individual should demonstrate the following competencies:

Analytical - Collects and researches data; Uses experience to complement data.

Problem Solving - Identifies and resolves problems in a timely manner; Gathers and analyzes information skillfully; Develops alternative solutions; Works well in group problem solving situations; Uses reason even when dealing with emotional topics.

Oral Communication - Speaks clearly and persuasively in positive or negative situations; Listens and gets clarification; Responds well to questions; Demonstrates group presentation skills; Participates in meetings.

Written Communication - Writes clearly and informatively; Edits work for spelling and grammar; Varies writing style to meet needs; Presents numerical data effectively; Able to read and interpret written information.

Teamwork - Balances team and individual responsibilities; Exhibits objectivity and openness to others' views; Gives and welcomes feedback; Contributes to building a positive team spirit; Puts success of team above own interests; Able to build morale and group commitments to goals and objectives; Supports everyone's efforts to succeed.

Customer Service - Manages difficult or emotional customer situations; Responds promptly to customer needs; Solicits customer feedback to improve service; Responds to requests for service and assistance; Meets commitments.

Judgment - Displays willingness to make decisions; Exhibits sound and accurate judgment; Supports and explains reasoning for decisions.

Professionalism - Approaches others in a tactful manner; Reacts well under pressure; Treats others with respect and consideration regardless of their status or position; Accepts responsibility for own actions; Follows through on commitments.

Other Skills and Abilities:

Ability to work with highly sensitive information while preserving the confidentiality of the information

Working understanding of Medicare (Part C or Part D preferred), medical terminology, medical coding background is preferred.

Intermediate level Microsoft Office skills to include Word, Excel and Outlook.