Customer Service Representative I (2796)

Purpose of Position:

The Customer Service Representative I handles calls from customers to resolve, educate, follow-up and respond to questions regarding California Choice/Choice Builder plan administration and procedures groups, members, brokers and general agencies.

Essential Functions:

• Understanding of company policies and procedures as they apply to California Choice/Choice Builder plans.

• Answers questions by telephone from groups regarding new hires, billings, rates, supplies, administrative procedures, etc.

• Educates, via telephone, employees/dependents regarding PCP’s, ID cards, RX problems, administrative procedures, dependent coverage, address changes, etc.

• Follows-up on calls and emails from brokers regarding problems that their groups are experiencing with providers.

• Ability to interact with brokers, general agents and sales representatives on a daily basis and must be able to answer questions regarding California Choice processes.

• Responds to calls from providers to confirm eligibility and benefits.

• Verifies enrollments and resolves issues with carriers.

• Expedites processing of members enrollment with carrier if urgent services are needed.

• Review and submit appeal requests from groups.

• Review /Audit group billing and explain to clients in clear and accurate manner.

• Document calls in call tracking system.

• Departmental standard requires each Customer Service Representative to provide Service of Unequalled Excellence to all callers by maintaining an average of 90% or greater on Call Reviews.

• Answer at least 100% of the daily call volume average.

• Provide clear and explicit documentation while maintaining percentage at a level of 90% or higher daily.

• Make busy time of 20 minutes or less per day.

• Meet department standards for quality and quantity of work.

• Meet department and team standards for turnaround times.

• Adhere to all HIPAA (Health Insurance Portability and Accountability Act) and PHI (Personal Health Information) guidelines.

• On-site regular attendance and punctuality are essential functions of the job.

• Performs other business tasks or functions as assigned.