Detroit Wayne Integrated Health Network · 5 hours ago
Customer Service Representative
Detroit, MI, US
Full-time
Hybrid
Senior Level
$60K/yr - $75K/yr
5+ years expDetroit Wayne Integrated Health Network (DWIHN) is seeking a Customer Service Representative to ensure that the Network’s Customer Service functions comply with state and federal regulations. The role involves providing information, referrals, and support to enrollees while facilitating problem resolution and monitoring customer satisfaction.
Mental Health Care
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
Qualification
Required
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
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
Experience working with the State mental health regulatory requirements
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
Company
Detroit Wayne Integrated Health Network
Detroit Wayne Integrated Health Network serves those with mental, developmental & substance use disorders.
501-1000 employees
Funding
Current Stage
Late StageLeadership Team
Dhannetta Brown
Deputy Chief Financial Officer
Stacie Durant CPA
Chief Financial Officer
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