Customer Service Representative I

Job Description Summary:

Under the direction of the Supervisor, Customer Service, this position is responsible for meeting KPIs while responding to general customer inquiries regarding insurance benefits, provider contracts, reimbursement programs, eligibility, and claims from members, providers and employers in a confidential, professional, and ethical manner. The incumbent will also research and analyze data to address standard operational challenges and issues within the Customer Service department.

QUALIFICATIONS

• High School diploma or GED and/or one (1) to three (3) years of experience in customer service within a call center environment, preferred.

• Knowledge of Health Benefits and eligibility preferred.

• Good communication and telephone skills with a very clear and concise speaking voice.

• Proficient written communication skills with the ability to learn new software and navigate multiple systems at once.

• Moderate keyboarding skills including proficiency with database management.

• Proficient organizational and time management skills.

• Adaptive in constantly changing environment.

• Skilled in researching and resolving standard technical issues or client problems as they arise.

• Good judgement, negotiation abilities and capacity to work with minimal supervision.

• Capable to learn and understand company’s end-user software programs.

• Ability to meet or exceed departmental service metrics.

• Fluent in English (oral and written) required. Bilingual in Spanish preferred.

• Internet access provided by a cable or fiber provider with 40 MB download and 10 MB upload speeds.

• Home router with wired Ethernet (wireless connections and hotspots are not permitted).

• A designated room for your office or steps taken to protect company information (e.g., facing

computer towards wall, etc.)

• A functioning smoke detector, fire extinguisher, and first aid kit on site.

DUTIES & RESPONSIBILITIES

Customer Advocate

• Respond to general customer questions via telephone, e-mail, and written correspondence regarding insurance benefits, provider contracts, reimbursement programs, eligibility, and claims in a confidential, professional, and ethical manner.

• Analyze problems and provide information/solutions.

• Research and resolve aged Customer Service open calls within company standards.

• Operate in the Health Care Processing System (HCPS), Imaging systems, and all systems necessary to obtain and extract information with proficiency and skills.

• Develop and maintain positive customer relations and coordinate with various functions within the company to ensure customer requests and questions are handled appropriately and in a timely

manner.

• Be accountable when you uncover an issue or trend by helping to assess and report its impact, making improvements, and course-correcting along the way.

• Follow quality guidelines to provide exceptional customer support and ensure scores meet or

exceed expectations.

Call Center Support

• Accurately document database activity and customer interaction for tracking and

analysis to identify trends and address operational and service issues.

• Research and analyze data to address standard operational challenges and customer service

issues.

• Provide customers with requested information, including difficult and upset customers.

• Meet or exceed all department and performance service metrics.

• Communicate with the appropriate departments and identify service issues.

• Identify inefficiencies within the established processes and suggest possible solutions to save time, reduce risk, and/or reduce expenses.

Other

• Maintain regular attendance per employee handbook guidelines.

• Utilize all capabilities to satisfy one mission — to enhance the competitiveness and profitability of our members. Do everything possible to help members succeed by being curious and striving to

understand what others are trying to achieve, planning, and executing work helpfully and

collaboratively. Be willing to adjust efforts to ensure that work and attitude are helpful to others, be

self-accountable, create a positive impact, and be diligent in delivering results.

• Maintain internet speed of 40 MB download and 10 MB upload and router with wired Ethernet.

• Maintain a HIPAA-compliant workstation and utilize appropriate security techniques to ensure HIPAA required protection of all confidential/protected client data.

• Maintain and service safety equipment (e.g., smo…