Job Description Summary

Qualifications

• High School diploma or GED and a minimum of two (2) 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 computing and keyboarding skills including proficiency with database management.
• Ability to adapt to a constantly changing environment.
• Proficient organizational and time management skills.
• 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 And Responsibilities

• Respond to general customer questions via telephone, e-mail, and written correspondence regarding insurance benefits, provider contracts, 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.
• 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, for actually helping, assess and report what is happening in terms of impact, making improvements, and course correcting along the way.

• Thoroughly document information, activities, and changes in the database and inquiry outcomes for accurate tracking and analysis.
• Research and analyze data to address operational challenges and customer service issues.
• Provide external and internal customers with requested information, including difficult and upset customers.
• Meet and maintain Quality and Telephone Performance measures per Customer Service Performance Report
• 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.
• Create and document a minimum of one new Standard Operating Procedure (SOP) annually.
• Identify, initiate, and implement at least one process improvement and/or innovation annually.

• 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, being self-accountable, creating a positive impact, and being 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., smoke detector, fire extinguisher, first aid kit).
• All other duties as assigned.

Physical Demands/Work Environment