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Call Center Representative

Call Center Representative

Essential Job Responsibilities:

  • Answer incoming and/or make outgoing calls to/from stakeholders, referral sources and new patients for the purpose of determining eligibility and scheduling new patient services within established time frames in a fast paced, high volume call center environment
  • Demonstrate the ability to prioritize and multi-task, operate multiple web based systems simultaneously, access and comprehend information to determine eligibility and/or insurance coverage, and perform data entry with a high level of accuracy.
  • Be able to easily accept and adapt to changes in procedures, programs and/or role functions based on the needs of the company and/or changes in the RBHA/Commercial insurance environment.
  • Validate all client eligibility via AHCCCS, RBHA, Insurance companies, etc., confirming services requested are covered contractually including reconciling eligibility/insurance coverage discrepancies.
  • Create, update and access confidential client data in company Electronic Health Record with a high level of confidentiality and accuracy.
  • Communicate effectively with both internal and external customers, including but not limited to notifying clinical staff of new patient appointments
  • Maintain internal department spreadsheet logs and/reports.
  • Utilizes the department team to discuss, enhance, and resolve issues


  • Answers 65% of incoming calls
  • Less than 10% of abandonment rate
  • Average call without a call center representative = 0
  • Average call time to remain the same
  • Average wait time is less than 2 minutes
  • Maximum wait time is less than 4 minutes

Communicates accurately, clearly, and professionally.

  • Communicates in a positive, respectful, and courteous manner.
  • Practices active listening skills and uses partnering communication strategies
  • Interacts with coworkers and the community to build productive and collaborative relationships to support the achievement of agency and program goals.
  • Understands and maintains private and sensitive information within the confines of need-to-know parameters.
  • Reviews email daily using various writing styles and formats to produce effective communication including a clear purpose and intent.
  • Maintains a calendar on a weekly basis that is available to supervisors and coworkers

Functions as an effective team member with co-workers and the community to build productive, collaborative relationships that support achievement of program goals and objectives.

  • Shares pertinent information with director, contractors, and team members regarding work progress, successes, barriers, concerns, and other areas that may have an impact on the department’s services or image, may affect relationships with key participating parties within the confines of need-to-know.
  • Attends and participates in staff meetings in accordance with department standards and schedule. Supports the decisions of the director and members of the management team to staff, participants, and the community.

Utilizes supervision effectively, takes initiative to secure professional development opportunities, and applies relevant information to the work setting.

  • Prepares and participates in supervision that is regular, reflective, and collaborative in nature.
  • Recognizes the personal limits of competencies and expertise, seeks supervision and guidance accordingly.
  • Maintains a reasonable level of awareness of current professional information in fields of activity and undertakes regular and ongoing efforts to maintain competence in the skills used.
  • Notifies supervisor of crisis situations, unusual incidents, and/or on-going problems within appropriate timelines (including reports to Child Protective Services).

Education, Experience, and Other Qualifications:

  • High School Diploma or G.E.D. Associates degree preferred.
  • 2 years or more of high volume/fast paced call center experience.
  • Experience with insurance verification, referrals, prior authorization or eligibility experience preferred, but not required.
  • Requires strong customer service skills
  • Excellent critical thinking skills
  • Requires a great attention to detail
  • Microsoft Office experience which includes Word, Excel, Access, and Outlook
  • Ability to understand and implement multiple contractual funding sources
  • Accurate data entry skills, ability to coordinate the completion of multiple projects and tasks at once
  • Bilingual preferred

This list of essential job responsibilities (EJR) and tasks are accurate as of the date reviewed. If the EJRs of this job changes, including physical or mental demands, a redetermination of the EJR should be done. Questions about the EJRs of a job should be addressed to the HR Department or Managing Supervisor for the position.

This list of EJRs and tasks are accurate as of the date reviewed. If the EJRs of this job changes, including physical or mental demands, a redetermination of the EJR should be done. Questions about the EJRs of a job should be addressed to the HR Department or Managing Supervisor for the position.

The above statements are intended to describe the general nature and level of work being performed by the person in this job and are not intended to be an exhaustive list of all responsibilities and skills required.

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