The purpose of the Telephone Customer Service Representative is to increase customer satisfaction and retention by providing members, customers, patients, and providers with accurate, consistent, timely, and meaningful information. Build rapport and collaborative relationships with current and prospective members in accordance with compliance guidelines.
Be available to handle member inquiries. Represent Health Plan by answering and documenting all incoming contacts to determine their nature, and respond to complex calls related to specialized product lines or questions.
• Respond with empathy to complaints and concerns from members concerning health plan benefits, account status, and medical services.
• Initiate contact with the appropriate health plan, medical group and facility personnel to obtain information relevant to the concern or inquiry as needed.
• Evaluate data to determine and implement the appropriate course of action to resolve the complaint and/or coordinate service recovery.
• Document according to procedure. Assist department in reaching call handling goals, first contact resolution goals, complaint resolution compliance, member retention and making return contact as warranted.
• Complete required training (including, but not limited to, annual certifications) and understand how to use tools available to recall necessary information.
• Be open and receptive to feedback, and change behavior to improve performance.
• Contribute ideas and recommendations for improvements to the department and company
• Adhere to compliance regulations and security policies
• Maintain high confidentiality regarding all services and products
Required Knowledge & Skills
• Must have excellent oral and written communication skills
• Extremely customer-focused; positive, professional attitude
• Willingness to learn and to take on new challenges
• Excellent interpersonal skills – be a team player, with the ability to work in close proximities, and use constructive problem-solving skills
• Demonstrate behaviors such as: willingness to put forth extra effort and time when needed
• Fundamental understanding how the job duties directly relates and affects the department and the organization
• Has substantial understanding of the job and applies knowledge and skills to complete a wide range of tasks. Ability to thoroughly understand a large, complex organization and its functional policies, processes, and customers.
• Minimum typing speed = 22 wpm and 92% accuracy
• Ability to think critically, with the aptitude to demonstrate analytical and problem-solving skills
Experience and Training Guidelines
• High School Diploma or GED required
• At least 1 years Customer service experience, demonstrating superior performance and consistent attendance in a call center environment.
• Health insurance experience preferred.
• Basic knowledge of computers required, including experience with Windows based environments.
• Demonstrate strong reading comprehension and writing skills to analyze and document interaction.
• Normal office environment
• Must be able to sit for extended periods of time
The statements above are intended to describe the general nature and level of work being performed by people assigned to this job. Other duties may be assigned as needed. Firstsource Transaction Services, LLC., is an equal opportunity employer that does not discriminate on the basis of age (40 & over), race, color, religion, sex, national origin, protected veteran status, disability, sexual orientation, gender identity or any other protected class in accordance with applicable law.