The Customer Service Representative is responsible for providing quality service by accurately and respectfully responding to telephone, written and electronic inquiries from employees/members, providers and clients. Inquiries include a variety of topics such as benefits, eligibility, claim status, claim disposition and so on. As a Customer Service Representative, you will have the ability to work from home and support clients in the Central and Eastern time zones.
What you’ll do:
- Respond to telephone, written and electronic inquiries from employees/members, providers, clients and other interested parties using system notes, plan documents and booklets, benefit reference documents, Claim Reference Manuals and claims-related memoranda.
- Treat all inquiries professionally and respectfully following Health Benefits guidelines
- Appropriately refer or escalate calls based on customer service procedures and guidelines.
- Research inquiries and respond appropriately.
- Appropriately refer unresolved inquiries or inquiries requiring further action to the appropriate individual, e.g. Analyst, Corrections, Senior, and Supervisor/Manager.
- Follow-up regularly on outstanding issues to ensure timely resolution and client satisfaction.
- Thoroughly and accurately document all inquiries using PowerSTEPP and Family Files following Health Benefits guidelines.
- Communicate via telephone, email, electronic messaging, fax, or written letter with employees/members, providers of service, clients and/or other insurance carriers to ensure proper claim processing and issue resolution.
- Initiate outgoing calls or other service projects as assigned.
- Other duties as needed/assigned
What you should have:
- Previous customer service experience is required.
- Ability to work in a fast-paced, customer-service driven environment
- Excellent verbal and written communication skills are required.
- Ability to work effectively with team members, employees/members, providers, and clients
- Ability to use common sense understanding to carry out instructions furnished in oral, written or diagram form.
- Flexible; open to continuous process improvement
- Ability to learn new/proprietary systems, to adapt to various system platforms, and effectively use MS Excel/Word.
- Prior experience in a fast-paced call center is strongly preferred.
- Must be able to work a flexible 37.5 hr. work week with a requirement to work between the hours of 8 am – 6 pm EST.
- Self-Funded Insurance/Benefits and/or TPA experience a plus.
- Knowledge of medical procedure, diagnosis coding, and medical terminology preferred.
- Bilingual preferred.
- Familiarity with Summary Plan Documents (SPDs)/Insurance Booklets or other benefit descriptive tools a plus.