The Customer Service Representative III performs complex (journey-level) customer service work and reports to the Office of the Inspector General (OIG) Fraud Hotline Manager in the Operations division. Work involves providing external customer service support and receiving and documenting public inquiries and reports of potential fraud, waste and abuse of agency programs and resources received through the Fraud Hotline. The CSR III communicates with the public primarily by phone, but also via email, mailed correspondence and by fax. The CSR III enters reports of potential fraud, waste, and abuse into various OIG systems, researches information to assist investigators and solves customer service issues by explaining agency programs, policies and procedures to the public. Handles off phone tasks such as processing mail and correspondence and responding to voicemails in coordination with the Manager and other Fraud Hotline staff. Creates and maintains activity logs and reports on work responsibilities. The CSR III may train others. Attends work on a regular and predictable schedule in accordance with agency leave policy and performs other duties as assigned. Works under general supervision, with moderate latitude for the use of initiative and independent judgment.
Essential Job Functions:
EJF 1: Answers Fraud Hotline calls to ensure optimal answer rates and accepts reports of fraud, waste, and abuse within the HHS system from callers. (40%)
EJF 2: Documents all allegations of fraud with accurate and concise written reports. Completes initial research of allegations using OIG and HHS systems. Completes these tasks in a call center setting which requires multi-tasking. (30%)
EJF 3: Works with Fraud Hotline Manager and co-workers to manage escalated calls. Provides customer service to callers by explaining agency programs, policies and procedures, and redirecting or transferring calls as needed. (20%)
EJF 4: Completes all assigned off phone duties and tasks within assigned timeframes and in accordance with procedures, updating tracking logs and escalating issues to management as appropriate. This includes responding to voicemails, accepting and documenting allegations received by e-mail, correspondence, or by fax and other tasks as necessary. Assists with the training of new staff as requested. (5%)
EJF 5: Monitors personal performance and call metrics and Fraud Hotline call volumes during the day to ensure average speed of answer, call handle time, and call answer rate are in compliance with established performance measures. (5%)
Knowledge Skills Abilities:
• Knowledge of office practices and administrative procedures.
• Knowledge of Medicaid and other State Program policies, rules, and regulations.
• Knowledge of contact center operational processes.
• Skill in the use of standard office equipment and software.
• Skill in handling calls in a customer service contact center environment.
• Skill in managing multiple, sometimes conflicting priorities without jeopardizing deadlines.
• Ability to type 45 WPM.
• Ability to respond to public inquiries and escalated customer issues in a timely manner.
• Ability to interpret and explain rules, regulations, policies, and procedures.
• Ability to train others.
• Ability to communicate effectively with the public and co-workers, both orally and in writing with tact and diplomacy.
• Ability to document work with accurate and concise written reports in a contact center setting which requires multi-tasking.
Registration or Licensure Requirements:
Initial Selection Criteria:
Graduation from an accredited high school or GED. Experience using a computer and a working knowledge of MS Word, Excel, and Outlook. Ability to type 45 WPM preferred. 2 years of interpreting and explaining Medicaid, State Program, or other complex policies, rules, and/or regulations in a customer service focused contact center preferred. Bilingual (English/Spanish) skills with the ability to answer phone calls in both English and Spanish preferred.
The OIG is responsible for preventing, detecting, auditing, inspecting, reviewing, and investigating fraud, waste, and abuse in the provision of HHS in Medicaid and other HHS programs. Potential employees of OIG are subject to criminal background checks in accordance with the HHS Human Resources policy. Selected applicants must submit to a name-based, or in some instances a fingerprint based, criminal background check through Texas Department of Public Safety (DPS) to determine if an applicant has a conviction for a Class A misdemeanor within the last five years or a felony that constitutes a bar to employment.
All applicants considered for an interview will be sent a request to provide responses to essay questions. Failure to respond to the request could disqualify an applicant from the interview process. An in-basket task will be required at the time of the interview.
This position will temporarily require teleworking. Successful applicants must provide high-speed internet service and have access to a designated home workspace. Satellite internet is not compatible with the tasks required for this position.
The posted salary range reflects the minimum and midpoint of the salary range allowable by state law. Any employment offer is contingent upon available budgeted funds. The offered salary will be determined in accordance with budgetary limits and the requirements of HHSC Human Resources Manual. In compliance with the Americans with Disabilities Act (ADA), HHS agencies will provide reasonable accommodation during the hiring and selection process for qualified individuals with a disability. If you need assistance completing the on-line application, contact the HHS Employee Service Center at 1-888-894-4747. If you are contacted for an interview and need accommodation to participate in the interview process, please notify the person scheduling the interview. HHS agencies use E-Verify. You must bring your I-9 documentation with you on your first day of work.
Note: There are no direct military occupation(s) that relate to the responsibilities, and registration or licensure requirements for this position. All active duty, reservists, guardsmen, and veterans are encouraged to apply if they meet the qualifications for this position.
HHS agencies use E-Verify. You must bring your I-9 documentation with you on your first day of work.
I-9 Form - Click here to download the I-9 form.
In compliance with the Americans with Disabilities Act (ADA), HHS agencies will provide reasonable accommodation during the hiring and selection process for qualified individuals with a disability. If you need assistance completing the on-line application, contact the HHS Employee Service Center at 1-888-894-4747. If you are contacted for an interview and need accommodation to participate in the interview process, please notify the person scheduling the interview.