Customer Service - Customer Service Representative 105-1055

JOB SUMMARY:

Responsible for being the first point of contact for all membership related questions, requests and concerns and for providing outstanding service to our customers.  You will answer queries regarding customer benefits, eligibility, PCPs, claims and other questions.  You will handle complaints, troubleshoot problems and provide resolutions in a professional and polite manner to ensure first contact resolution and customer satisfaction.  The ideal Customer Service Representative will be customer focused, detail oriented and results driven.  The most successful Customer Service Representatives demonstrate the following characteristics:  polite, accurate, knowledgeable, able to work well within a team, learning agility, flexible and easily adapts to change. 

KEY RESPONSIBILITIES:

• Process a high volume of incoming inquiries regarding multiple products from members, providers, billing companies, individuals with legal representation, employer groups, and other insurance companies. 
• Strive to achieve first call resolution by communicating accurate information efficiently and timely thereby creating a positive experience for the member.
• Verifies eligibility, benefits, deductible amounts, claim status, copays, coinsurance and all other information related to a customer and their benefits or a provider and their contract.  
• Use effective listening skills to understand the needs and complaints of the customer to offer them the best possible solution and ensuring the member feels supported and valued.
• Resolve escalated customer issues received from the member, provider, employer groups or brokers while remaining calm and professional.
• Provide interpretation services for all product lines via the contracted language line service as appropriate.  
• Flexible hours, including weekends and evenings, as department or training needs dictate and at the discretion of management may be required.
• Effective problem resolution skills that demonstrates balance of company and customer needs.
• Demonstrated ability and learning agility to adapt to organizational changes including business processes, systems and technology.
• Joining a team of Customer Service Representatives and building a positive relationship of teamwork, trust, reliability and excellence.
• Understanding and striving to meet or exceed call center metrics while providing excellent customer service.
• Taking part in training and other learning opportunities to expand knowledge of company and position.
• Perform other duties as assigned.

QUALIFICATIONS:

• Exceptional telephone manner, customer service skills, active listening skills, verbal and written communication skills.
• Ability to resolve conflict and diffuse tension
• Strong time management skills and decision- making skills.
• Ability to read, comprehend, and explain health insurance benefits in a clear, concise, and professional manner.
• Ability to work under stress with production and quality standards.
• Proficient in Microsoft Office applications.
• Highly organized and attentive to detail.
• Flexibility, ability to adapt to change.
• Successful completion of Health Care Sanctions background check.
• Bilingual skills a plus.

EDUCATION/EXPERIENCE:

• High school diploma or equivalent required
• 1-year customer service experience with direct interactions with customers
• Contact center or medical field experience preferred