Customer Service Representative

Talent is our most important resource. Our teams are innovative, focused, and hard working. We ask our employees to challenge themselves, and they consistently rise to the occasion in an ever-changing industry. With a strong history in our community, our employees are proud to work here. We work as a team to help our members and community live healthier lives. We want to empower our employees with resources to achieve a healthy work-life balance.

Job Description

Duties Note: The following is not intended to be an exhaustive list of all duties required of this position.

ADA

E1. Provide timely, accurate, and courteous responses to a high volume of telephone inquiries from both members and providers.

E2. Achieve and maintain productivity and quality performance expectations.

E3. Interpret and effectively communicate benefits, eligibility, and claims payment information to our customers.

E4. Document all critical information related to contacts responded to in the appropriate system.

E5. Manage pending inventory in a timely and accurate manner in order to meet or exceed quality and productivity standards.

E6. Effectively navigate through multiple complex systems/screens.

E7. Provide timely follow-up with other internal departments to expedite resolution of difficult/aging inquiries, and when necessary escalate those issues to management for further handling.

E8. Keep familiar with all system, contractual, compliance standard changes and policy updates, and attend additional training sessions as necessary.

E9. Comply with all HIPAA Compliance regulations.

E10. Compliant with company policy on attendance.

Education/Experience/Skills Requirements

Required Education: Required Experience:

HS/GED:Preferred Education: Associates Degree in Business and/or Health Care related field preferred;High School Diploma or GED; Preferred Experience: Minimum 1 year experience in Customer Service, Health Care or Insurance. Previous experience working in an ACD call center is a plus.

Required Knowledge/Skills:

1. Must meet minimum qualifications to perform work including satisfactory completion of training and testing

2. Ideal candidate must be a problem solver and tactful when dealing with callers

3. Demonstrate the ability to work and multi-task in a fast paced environment

4. Displays excellent interpersonal skills and is a team player

5. Ability to use PC and office equipment

6. Working knowledge of Microsoft Office

7. Must have good organizational and time management skills and be detail oriented

8. Trainees: Must pass 2 of 3 written tests given during training with a 90% or greater; Must pass a live call test; Must pass 7 of the 8 calls reviewed; Must meet or exceed the department quality statistic for a rolling six month continuous period; Must be in good standing (no verbal or written warnings) and demonstrate core values; Must have a 3.0 or above rating on latest performance review.

9. Existing Employees: Must meet or exceed the department quality statistic for a rolling six month continuous period; Must be in good standing (no verbal or written warnings) and demonstrate core values; Must have a 3.0 or above rating on latest performance review.

Required Licenses/Certifications:

Problem Solving

Must demonstrate the ability to independently research their reference materials and other documentation before going to a team lead or the supervisor for assistance.

Managerial/Supervisory Responsibilities

Does this Position have Supervisory Responsibility? No

Number of Emps Supervised:

Titles of Employees Supervised:

Financial/Budgetary Responsibilities:

Other Job Specifications:

External Contacts: Subscribers, Members, Providers. Vendors who oversee behavioral health items on behalf of groups, precertification for radiology services, vision benefit vendors, chiropractic care oversight vendors, etc.

Working Conditions/Physical Demands:

Position requires:

• Must be able to work in an office environment

Position involves:

• Heat, light, air, space and working environment typically found in an office environment

• Manual Dexterity Req: Eye-hand coordination and manual dexterity sufficient to effectively use a computer with all its components for prolonged periods of time and for the majority of required tasks

• Manual Dexterity Req: Eye-hand coordination and manual dexterity sufficient to effectively utilize various office equipment (phone, computer, fax machine, printer, copier, filing cabinet, etc)

• Mental effort: Adequate to perform essential functions of the job with the type of judgements and responsibilities as indicated in the job description.

• Physical Effort: Minimum; typical of most office work. Mostly sedentary work.

• Vision Req: Close vision (clear vision at 20 inches or less)

• Prolonged Sitting

• Weight: lift/carry/push/pull under 10 lbs.

• Lifting - 6% to 33% - Occasional

Work Schedule

All qualified applicants will receive consideration for employment without regard to race, color, religion, sex, national origin, protected veteran status, or disability status.

*If you are a current employee, please use the company's intranet to express your interest in advancing your career.