As a Customer Service Representative you will: directly respond to questions, handle issues and provide guidance on transactions, inquiries or complaints from both internal and external customers. External customers would include members and providers. Receive, documents and resolve customer inquiries by using established best practices. Build lasting relationships with client members. Educate members and providers about products and services over the telephone.
- Must be open to working either of the following shifts: 8am-5pm OR 11am-8pm
- Minimum of 2 years Health Care/Insurance experience
Experience, Qualifications and Education:
- High school diploma or general education degree (GED).
- Minimum of 2 years Healthcare/insurance experience.
- Proficiency in all Microsoft Office Programs, including Word, PowerPoint, Excel, and Access.
- Ability to type 30-45 wpm.
- Prior Customer Service & Claims adjudication experience in the healthcare field along with working knowledge.
- Respond to complex customer calls.
- Resolve customer service inquiries which could include: Benefit and Eligibility information; Billing and Payment issues; Customer material requests; Physician assignments; Authorization for treatment; and Explanation of Benefits (EOB)
- Must be able to handle volatile situations and act urgently when necessary.
- Must be willing and able to work flexible hours, including some weekends during specific times of the year and over time when needed.
- Makes outbound calls to any source needed to resolve open issues including but not limited to members, providers, pharmacies, hospitals etc.
- Issue form letters & forms, when appropriate.
- Investigates and respond to general correspondence, which may result in a variety of additional actions.
- Must have strong investigative, problem solving skills.
- Must be very detailed oriented and organized.
- Ability to interact with other department s i.e. Enrollment, medical management in resolving issues.
- Familiarity with computer and Windows PC applications, which includes the ability to learn new and complex computer system applications.