Job Details
Customer Service Representative
Description **Job Purpose**
The Customer Service Representative addresses inquiries, questions and concerns in all areas including enrollment, eligibility, claims, benefit interpretation, and referrals/authorizations for medical care. The position is responsible for receiving, responding to, and directing member, broker and provider phone calls and other communications and provides available information upon request and escalates issues as appropriate.
Requirements **Duties and Responsibilities**
* Receives customer calls or inquiries, which include potential/current/previous members, brokers and providers, and routes appropriately
* Provides timely and accurate information to customers
* Processes customer requests according to established department policies and procedures
* Completes research and investigative activities to address customer inquiries
* Works closely with other departments to gather information
* Provides timely feedback to customers through outbound calling, email, mail or fax
* Provides timely feedback to the company regarding service failures, systemic issues or customer concerns
* Assists in the completion of special projects
* Assists in the documentation, evaluation and revision of department policies and procedures
* Meets or exceeds service level agreements in call center metrics
* Attends and participates in meetings and trainings as required
* Regular and predictable attendance
* Consistently demonstrates compliance with HIPAA regulations, professional conduct, and ethical practice
* Maintains work area in a clean and orderly condition and ensures safe operating conditions within area of responsibility
* Works to encourage and promote Company culture throughout the organization
* Other duties as may be assigned
**Qualifications**
* Requires a high school diploma or its equivalent
* preferred
* Bilingual preferred
* Ability to learn quickly and be self-motivated
* Knowledge of healthcare billing and claims preferred
* Insurance experience preferred
**Competencies**
* Ethics Honest, accountable, maintains confidentiality.
* Reliability The extent to which the employee can be depended upon to be available for work, do it properly, and complete it on time. The degree to which the employee is reliable, trustworthy, and persistent.
* Sense of Urgency Meets deadlines, establishes appropriate priority, gets the job done in a timely manner.
* Customer Service Works will with customers, promotes a positive image of the company, strives to solve issues raised by customers.
* Communication Skills Possesses effective communication skills: oral, written, listening.
* Computer Skills Skilled with computers, takes advantage of new technology, learns new tools quickly, uses technology to enhance job performance.
* Conflict Management Good listener, committed to finding solution to problems, works well with difficult people.
* Cooperation Willingness to work harmoniously with others in getting a job done. Readiness to respond positively to instructions and materials.
* Initiative Takes action, seeks new opportunities, strives to see projects to completion
* Job knowledge Knowledge of products, policies and procedures; OR knowledge of techniques, skills, equipment, procedures, and materials.
* Organizational Skills Information organized and accessible, maintains efficient workspace, manages time well.
* Problem Solving Displays ability to recognize a problem, trouble shoots to ascertain the extent of the problem, and selects appropriate alternative to investigate or resolve the problem.
**Physical, Mental, Environmental & Working Conditions**
Significant amount of sitting and typing. Moderate amount of walking and writing. Moderate to significant amount of stress in meeting deadlines and dealing with day-to-day events in the execution of job duties. Needs flexibility and adaptability to change. Candidate must be self-disciplined and a self-starter and able to work independently with a flexible work schedule.