• ACA Exchange Customer Service Representative

    AmeriHealth Caritas Philadelphia, PA 19133

    Job #2279937101

  • ACA Exchange Customer Service Representative

    Location: Philadelphia, PA

    Primary Job Function: Operations

    ID**: 24755

    Your career starts now. We're looking for the next generation of health care leaders.

    At AmeriHealth Caritas, we're passionate about helping people get care, stay well and build healthy communities. As one of the nation's leaders in health care solutions, we offer our associates the opportunity to impact the lives of millions of people through our national footprint of products, services and award-winning programs. AmeriHealth Caritas is seeking talented, passionate individuals to join our team. Together we can build healthier communities. If you want to make a difference, we'd like to hear from you.

    Headquartered in Philadelphia, AmeriHealth Caritas is a mission-driven organization with more than 30 years of experience. We deliver comprehensive, outcomes-driven care to those who need it most. We offer integrated managed care products, pharmaceutical benefit management and specialty pharmacy services, behavioral health services, and other administrative services. Discover more about us at ~~~ .

    This role is eligible for a $1500 Sign-on Bonus for external candidates


    Under the general direction of the ACA Operations Supervisor, responsible for responding in a timely, professional and courteous manner to all and member needs. This includes inbound and outbound phone calls or correspondence regarding benefit, eligibility, member premium billing, and other member issues. Provides member education and assists members with PCP selection and assignments. Assists with access to care and wellness program. Demonstrates solid knowledge of the Affordable Care Act regulations, functions and team process. Demonstrates superior skill in dealing with member issues/inquiries, team members, and co-workers. Follows internal processes and procedures to ensure all activities are performed in accordance with departmental and company policies and procedures.

    • Demonstrate passion for providing superior customer service to our customers and continually seeks to understand the needs of those we serve.

    • Create accurate and timely member documentation concerning all inquiries taken in accordance to established protocols to ensure resolution is provided and presented in a clear and accurate manner.

    • Present and project a positive image of the company in and out of the office to fellow associates, members, providers and the community by being courteous, helpful, energetic, respectful and polite.

    • Strive to resolve an inquiry on first contact while ensuring that the inquiries have been addressed to the customer's satisfaction by using all resources in an efficient and timely manner.

    • Provide feedback and/or solutions to supervisor to ensure continuous process improvement and provide a better customer experience.

    • Creates and supports an environment which fosters teamwork, cooperation, respect and diversity.

    • Maintain an awareness of all product knowledge information.

    • Maintains an awareness of Affordable Care Act regulations with regard to enrollment, billing, grace periods, special enrollment periods, and open enrollment.

    • Understanding of the CMS Marketplace Help Desk role and directs members to CMS in accordance with that role.

    • Able to respond to inquiries for HICS casework status

    • Able to respond positively to support change within the department and the company.

    • Ability to assist members with premium billing inquiries and/or issues.

    • Forwards claims requiring external department intervention to the appropriate department or person. Monitors outstanding inquiries and works with management staff to identify and resolve areas of non-compliance.

    • Reviews and verifies quality audit reports. Reconciles audit discrepancies, corrects in system and make appropriate changes to avoid recurrence.

    • Responds to and resolves member and health plan claim inquiries.

    • Actively participates in user acceptance testing functions, such as test script development, testing and documentation of test results.

    • Willing to be flexible regarding job responsibilities and schedule, not limited to but including, overtime and holidays, as a result of contractual business requirements.

    • Routinely meet or exceed key performance indicators.

    • Perform other duties as assigned.


    • High School/GED.

    • Minimum 4 years' experience in claims and/or call center .

    • Associate degree preferred; Minimum 45 wpm typing preferred; Commercial Healthcare or Managed Care experience preferred; Working knowledge of PC apps in a windows based environment; Excellent judgment and decision-making skills in dealing with complaints and sensitive requests required.

    EOE Minorities/Females/Protected Veterans/Disabled