Customer Service Representative

Job Description

Job Description

CUSTOMER SERVICE REPRESENTATIVE

Under the general supervision of the Customer Service Administrator, the Customer Service Representative is responsible for assuring that the Network’s Customer Service functions are carried out in accordance all state and federal regulations and contractual requirements regarding Customer Service as established for the Pre-Paid Inpatient Health Plan (PIHP), the Michigan Mental Health Code mandates, Michigan Department of Health and Human Services (MDHHS) contract, Balanced Budget Act (BBA), and Detroit Wayne Integrated Health Network (DWIHN) Customer Service Standards.

PRINCIPAL DUTIES AND RESPONSIBILITIES:

• Provides applicable Customer Service information,referrals,linkages, and follow-up for telephone, email, and walk-in inquiries.
• Facilitates inquiries regarding behavioral health, substance use disorders, dual eligibility, choice opportunities, family subsidy, etc.
• Provides systems navigation services such as the DWIHN website and Mental Health Wellness Information Network (MHWIN).
• Provide clarification of Explanation of Benefits (EOBs) to those enrollees who were in receipt of services, and answer enrollee claim status inquiries.
• Facilitates problem identification, clarification, and resolution assistance.
• Documents and refer to applicable inquiries regarding complaints, grievances, appeals, and dispute resolutions for appropriate follow-up.
• Provides direction, information, and educational materials to intended beneficiaries regarding enrollee rights and responsibilities.
• Provides and promotes self-advocacy, community inclusion, and peer support resource referrals.
• Provide support to enrollees and providers as needed.
• Assists with monitoring customer satisfaction.
• Conducts and participates in Customer Service phone and written surveys.
• Participates in the Customer Service data gathering applicable to the Customer Service Unit.
• Assists with the facilitation of planned training events.
• Assists with community and enrollee outreach activities.

• Interacts with contracted and non-contracted community agencies.
• Participates in Customer Service quality improvement activities, i.e., Mystery Shopping.
• Attend applicable network-related meetings and training as necessary.
• Performs related duties as assigned.

KNOWLEDGE, SKILLS, AND ABILITIES:

• Knowledge of mental health standards and practices.
• Knowledge of Customer Service principles and practices
• Knowledge of Customer Service MDHHS regulations.
• Knowledge of DWIHN policies and procedures regarding Customer Service.
• Knowledge of the BBA.
• Knowledge of Recipient Rights related to services provided to enrollees.
• Knowledge of the Michigan Mental Health Code.
• Knowledge of the DWIHN provider network.
• Technical Proficiency, the ability to navigate computer skills, Microsoft (Excel, Word, Outlook), and phone systems.
• Organizational skills
• Critical thinking skills
• Teamwork skills.
• Conflict Resolution Skills

• Interpersonal skills
• Interviewing skills
• Ability to communicate orally.
• Ability to communicate in writing.
• Ability to work professionally and effectively with others.
• Ability to work with an ethnically, linguistically, culturally, economically, and socially diverse population.
• Judgement/Reasoning ability

REQUIRED EDUCATION:

A bachelor’s degree from a recognized college or university in Human Service, Social Service, Public Health, Public Administration, Healthcare Administration, Health Management, Business Administration, Conflict Resolution, Criminal Justice, Psychology, Counseling, Social Work, or a related field.

REQUIRED EXPERIENCE:

Five (5) years of full-time paid experience performing duties and responsibilities in the following areas:

• Experience working in a customer service environment in a mental health setting
• Experience working with complaints, grievances, and appeals.
• Experience working with enrollees, training, peer counseling, and advocacy.

 

OR

• Experience working with the State mental health regulatory requirements.

NOTE:

Education in Human Service, Social Service, Business Administration, Criminal Justice, or a related field may be substituted on a year-for-year basis for required experience.

WORKING CONDITIONS:

Work is usually performed in an office setting. Currently, this position is a hybrid position.

This description is not intended to be a complete statement of job content, but rather to act as the essential functions performed.  Management retains the discretion to add or change the position at any time. 

Please note: DWIHN requires proof of being fully vaccinated for COVID-19 as a condition of employment. Medical or religious accommodations or other exemptions that may be required by law will be approved when properly supported. Further information will be provided during the recruitment process. 

 

The Detroit Wayne Integrated Health Network (DWIHN) is an Equal Opportunity Employer