CUSTOMER SERVICE REPRESENTATIVE

Job Summary:Responsible for customer service calls from providers and members. Provides information, resolution, and assistance to callers. Acts as "first impression" person representing employer to visitors and callers. Provides clerical assistance to all departments as directed by UM Support Services Director.Essential Job Functions:Reasonable accommodations will be made to enable individuals with disabilities to perform the essential functions of the position.Provides a full range of assistance to provider and members or their representatives via telephone or correspondence concerning eligibility, selection of primary care physicians and claims.Answers telephone in a prompt, professional, courteous and helpful manner; screens and directs calls to appropriate staff member/department. Responds to routine requests for information. Makes outbound calls to set up patient appointments with the members PCP or a Specialist after a hospital admission. Process online external communication throughout (CS Tickets) the day between calls. Prepares, prints, and distributes variety of system-generated reports/letters on schedule, using report software. (Includes: -0- net explanation of benefits, acknowledgement letters, authorization letters, and customer service reports). Interviews provider and members or their representatives to determine the nature of their problem or interest. Explains technical provisions and elicits relevant facts. Documents and investigates provider and member complaints and reconciles discrepancies. Pursues to completion incidents of dissatisfaction.Responsible to maintain and log accurate phone calls in the Customer Service module in Portal. Demonstrates a comprehensive knowledge of Health Plan Benefits and the various departmental functions. Analyze and identify concerns/issues and refer to appropriate department if deemed necessary. Investigates and resolves systems-identified discrepancies and situations. Performs a variety of routine clerical functions as assigned to include, but not limited to, filing, photocopying, proofreading and verifying documents for accuracy and completeness. Prepares standard forms and routine reports. Compiles simple data, resolving or rejecting errors and omissions.Performs related duties consistent with the scope and intent of the position.Regular attendance.Travel as required.Other Functions:Enforces Company policies and safety procedures.Regularly updates job knowledge by participating in educational opportunities, reading professional publications, maintaining professional networks, and participating in professional organizations.CompetenciesMinimum 1 year of customer service related experience.HMO/IPA experience preferredAbility to consistently deliver excellent customer service.Excellent communication skills, including both oral and written.Excellent active listening skills.Ability to solve entry to mid-level problems with minimal supervision.Ability to demonstrate professionalism, confidence, and sincerity in a diverse work culture.Ability to multi-task, exercise excellent time management, and meet multiple deadlines.Ability to provide and receive constructive job and/or industry related feedback.Ability to exercise strict maintenance of confidentiality of all confidential and sensitive communications and information.Excellent attention to detail and ability to document information accurately.Ability to effectively and positively work in a dynamic, fast-paced team environment and achieve objectives.Demonstrate commitment to the organization's mission.Must have mid-level skills in MS Word/Excel.Must have the ability to quickly learn and use new software tools.Must have mid-level skills using e-mail applications.Self-motivated with strong organizational, multi-tasking, planning, and follow up skills.Ability to work independently as well as in a team environment.Ability to present self in a professional manner and represent the Company image.Education and LicensureHigh School Diploma or GED requiredAA degree in related field is required/preferred

Created: 2024-11-12