Texas Licensed Managed Care Representative

Job Summary

A company is looking for a Managed Care Representative II - Remote.

Key Responsibilities

• Respond to inquiries from health plan members, providers, and customers while meeting productivity and quality standards
• Utilize software to provide concierge services related to health plan operations, including benefit interpretation and claims resolution
• Handle member and provider calls for various health plan types, including self-funded and Medicare Commercial plans

Required Qualifications

• High School Diploma
• 2+ years of experience in a health care or insurance environment
• Knowledge of health care delivery systems and Texas Department of Insurance regulations
• Solid understanding of HMO Plan Design and Claims Processing
• Proven ability to build and maintain productive working relationships with customers