§
Assist members with routine service inquires including but not limited to; selecting a primary care physician, member benefit education, member identification cards, transportation
arrangements, issues with provider accessibility, eligibility inquires, resolving member complaints, identifying and filing member grievances
§
Provide quality service by immediately responding to the member and/or providers requests and complaints, and appropriately routing issues to the correct department for
timely resolution
§
Assist members with processing their premium payments
§
Assist a provider with routine service inquires including but not limited to; verifying eligibility, explanation of benefits, claims and appeal procedures
§
Capture member grievance, and relay appeals instructions for the appropriate line of business, including future lines of business
§
Ensure all HIPAA and State requirements/regulations are adhered to at all times, in existing and future lines of business
§
Research, follow up, and resolve all open/pending issues in a timely manner to ensure member satisfaction
§
Build and strengthen member relationships by providing quality customer service
§
Maintain knowledge and understanding of all processes and procedures
§
Adhere to all departmental and company policies and procedures
§
Maintain complete and accurate documentation of all of telephone and written communications
§
Act as a mentor to new hire employees
§
Screen members to determine Case Management needs, and refer when appropriate
§
Appropriately route calls to support departments including Pharmacy, and Triage, for proper/expedited resolution
§
Assist with non-phone work such as incoming faxes and web inquires
Perform any other job related instructions, as requested
Requirements
Education / Experience:
§
High School Diploma or equivalent is required
§
Two (2) years customer service experience is preferred
§
Customer Service experience in a call center is preferred
Required Competencies / Knowledge / Skills:
§
Computer proficiency with knowledge and experience in a “Windows” environment
§
Typing speed of 35 words per minute (WPM)
§
Strong written and communication skills
§
Professional phone etiquette
§
Proper use of grammar
§
Ability to work in a fast paced environment
§
Adaptable to a constantly changing environment
§
Attention to detail
§
Ability to multitask
§
Ability to work independently and with a team
§
Critical thinking and listening skills
§
Decision making and problem solving skills
Licensure / Certification:
§
None
Accountability:
Working Conditions:
General office environment; may be required to sit/stand for long periods of time
EmoticonEmoticon