Customer Service Representative

Position Summary:

• Respond to and resolve various customer inquiries via telephone and correspondence, and resolve claims problems within established production and quality standards.
• Answer incoming calls and written requests for information from members or providers promptly and accurately.
• Compose routine and non-routine correspondence to answer member inquiries that require a written response.
• Coordinate with other departments to ensure timely and appropriate responses.
• Expedite and resolve complex issues and make claim adjustments.
• Educate others on the client product, providing accurate information and updates to policies and procedures, improving overall customer satisfaction in the process.
• In the Lead role, you will deal with the most complex cases and issues as an individual contributor or may focus on mentoring and acting as a backup for supervisory responsibilities.
• May assist in scheduling and coordinating team activities.
• Typically provide input in hiring decisions and performance appraisals.
• Handle the highest level of escalated and unresolved calls.

Your responsibilities will include but are not limited to:

• Successfully complete tier 2 training which covers some of the following:

• Handles escalated calls; may de-escalate calls
• Responds to member benefits in writing
• Peer to peer coaching /training

• Perform inventory reduction, routine to mid-level, (i.e. member inquiries, may adjust claims, responds to emails, etc.).
• May expedite, research, and resolve complex issues.
• Consistently perform established performance metrics, such as quality, production; average handling time (AHT) and calls per hour (CPH).
• Work with minimal supervision.

Requirements:

• Successfully meets requirements of nesting audit.
• Have strong customer service experience (especially phones) and a proven ability to meet performance standards.
• Strong organizational skills.
• Ability to work independently and to mentor others
• Ability to interpret the various health plans and any documentation associated with them.

$15.50/Hr