Customer Service Representative, Pacific/Mountain Time Zone
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Job Description
Customer Service Representative managing customer inquiries regarding insurance benefits and eligibility. Analyzing data and providing exceptional service to improve customer relationships while meeting KPIs.
Responsibilities:
- 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.
- 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.
- Maintain regular attendance per employee handbook guidelines.
- Utilize all capabilities to satisfy one mission — to enhance the competitiveness and profitability of our members.
Requirements:
- 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.
Benefits:
- rich benefits package that includes profit-sharing.
- flexible work arrangements with work-from-home, in-office or hybrid options.
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