Customer Service Representative

The Customer Service Representative is responsible for promoting favorable interaction with patients, providers and payers through prompt, accurate and courteous resolution of telephone and written inquiries. This position is primary responsible for inbound calls relating to medical, pharmacy, vision, and related healthcare options. Duties and Responsibilities: Assist with questions, complaints and concerns as well as explanation of policies and procedures. Receive inbound calls from patients, providers and members; occasionally return calls. Apply a variety of concepts, best practices and follow policy and procedures. Provide responses to inquiries and complaints for all phases of operations including billing claims, denials, payments and others. Explain account situations to ensure member understanding. Respond promptly to written inquiries or provide call backs from messages. Aim to resolve inquires on the first call by being proactive and demonstrating product knowledge. Meet or exceed performance metrics including quality, accuracy, call handling time and member satisfaction; standards may be revised. Escalate advanced issues as appropriate. Requirements Required Knowledge, Skills, and Abilities : HS Diploma or equivalent. 1 year of customer service experience is a medical/healthcare setting including knowledge of medical terminology, how to read and explain a claim or EOB and working in a production environment. Solid working knowledge of standard computer applications including MS Word, Excel, Outlook, and PowerPoint. Ability in using a computer which includes expert keyboard and navigation skills and learning new programs. Communicate clearly and professionally with internal and external customers. Work effectively as part of a team to achieve established outcomes. Understand other's roles and empower one another to take responsibility to be successful. Demonstrate a collaborative interaction with peers to reach a common goal. Demonstrate a collaborative interaction with peers to reach a common goal as well as be a resource to team members and internal/external customers. Pay close attention to detail in all aspects of the job. Make decisions using available resources and sound judgment. Maintain confidentiality and discretion. Identify and resolve problems in a timely manner, gather and analyzes information skillfully. Share knowledge with associates by effectively communicating and providing follow-up. Open to other's ideas and exhibits a willingness to try new things. Demonstrate accuracy and thoroughness; monitor work to ensure quality. Prioritize and plan work activities to use time efficiently. Adapt to changes in the work environment, manage competing demands and is able to deal with frequent change, delays, or unexpected events. Follows instructions, responds to direction, and solicits feedback to improve. Act in such a way to instill trust from management, other associates, as well as customers. Work overtime as required Physical and Cognitive Demands: The demands described here are representative of those necessary for an employee to successfully perform the essential functions of this job. Reasonable accommodation can be made to enable individuals with disabilities to perform the essential functions. Constant: Talk, hear, speak, and use hands and fingers to operate a computer, telephone, keyboard/mouse; occasionally move about the office Constant: Visual ability such as close vision, distance vision, color and peripheral vision, depth perception and ability to adjust focus Occasional: Lift and/or move up to 30-50 pounds Constant: Regular, predictable attendance in the office is required Constant: While performing the duties of this job, the employee is regularly sitting for the full shift Constant: The cognitive skills needed to complete tasks include abilities such as learning, remembering, focusing, categorizing, and integrating information for decision making, problem-solving, and comprehending. Work Environment: The work environment described is representative of what must be met by an employee successfully perform the essential functions of this job. The physical environment is indoors in a controlled climate, office setting. The noise level may be low to moderate. The duties described are representative, but not restrictive of tasks that may be assigned or of the abilities required to do the job. The description is subject to change at any time. Other related duties may be assigned. This description does not alter the at-will status of employment.