Sr. Call Center Rep - The Health Plan

Position: Sr. Call Center Rep - The Health Plan

Job ID: 150857

Location: US-TX-Bellaire

Department: Member Services - Inbound

Talent Area: Administrative Support

Full/Part Time: Full-Time

Regular/Temporary: Regular

Shift: 7a - 11p Monday - Friday; 7a -7p Sat/Sunday

About Texas Children's Hospital

The Texas Children’s Hospital system is the largest pediatric integrated care system and is an industry leader in pediatric population health.    Founded in 1996, Texas Children’s Health Plan is the nation's first health maintenance organization (HMO) created just for children and pregnant women.  We are an Integrated Community System providing holistic care that empowers families to live healthier lives.  Texas Children's Health Plan is also the largest combined STAR/CHIP Managed Care Organization in the Harris County service area.  Currently, the Health Plan serves more than 450,000 members across three state territories (Harris, Jefferson, North East), who receive care from our network of more than 1,100 primary care physicians, 3,200 specialists, and 70 hospitals. To join our community of 13,000 dedicated team members, visit for career opportunities. You can also learn more about our amazing culture at


We are searching for a Senior Call Center Representative— someone who works well in a fast-paced setting. In this position, you will serve as a member and/or provider advocate that understands the organization's processes, policies, and procedures to investigate, resolve and/or facilitate the resolution of simple to complex issues/questions. You will be the first point of contact for assistance or information regarding eligibility, benefits, authorizations, claims, referrals and/or any other member/provider demands. Lastly, you will assist and advocate for members and/or providers throughout the complaint and appeal process and support members with timely appointment scheduling.


Think you’ve got what it takes?

Responsibilities :

Job Duties & Responsibilities

  • Act as a secondary resource to Call Center Representatives in the absence of the Team Lead and responds to escalated calls and triages to management, if necessary
  • Identify and handle a variety of routine to complex customer or prospect inquiries or requests
  • Educate members about their health coverage benefits and services and empowering members/providers by directing them toward available resources for self-help
  • Meet Senior Member Service Representative performance goals for customer satisfaction, quality, productivity, and all performance metrics
  • Ensure all HIPAA and state privacy and confidentiality requirements/regulations are adhered to at all times
  • File complaints and appeals on behalf of members and providers within the regulatory timeframe and in compliance with departmental policies and procedures


Skills & Requirements

  • High school diploma or GED
  • Minimum of 3 years of customer service experience within managed care or insurance industry or
  • Or call center experience within any industry
  • A Bachelor's degree may substitute for two (2) years of the required experience
  • Bilingual and previous Healthcare related experience preferred


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