Customer Service Representative - Claims

Overview:
The Customer Service Representative provides outstanding customer service related to Veteran care through the Community Care Network (CCN) in a fast-paced contact center. Responds to inbound calls and chat messages regarding authorizations for medical and behavioral health care, provider status and availability, or claims payment and status. Accurately assesses caller requests, answers caller inquires and processes requests while focusing on first call resolution and/or appropriate call escalation protocols. May makeoutbound calls to schedule appointments based on Veteran or VA request. Resolves administrative eligibility discrepancies through account research and review.

What you will be doing:

• Manages multiple tasks lists in accordance with directed timelines. Meets call volume, chat volume, schedule adherence, quality, Veteran appointment and other production standards.

• Initiates and receives phone calls, chat messages and emails from VA medical center staff, and providers to answer claims, eligibility, benefit and program questions. In select markets, facilitates appointment scheduling of Veterans through outbound solicitation to providers. Records preferences, tracks Veteran questions thoroughly in the Customer Relationship Management systems and Portal, as well as VA’s HSRM systems.

• Consistently displays professional and courteous service skills to internal and external customers.

• Accurately resolves VA and provider inquiries with a focus on first call resolution.

• Protects the privacy of health information of patients when using or disclosing Protected Health Information (PHI).

• Takes appropriate measures to comply with HIPAA regulations to protect privacy of customers' health information.

• Documents all communications involving Veteran and provider contacts. Uses critical thinking in problem solving and follows established processes to assure quality program compliance.

• Consistently meets department productivity and performance metrics to include regular and consistent attendance.

• Participates in cross training, employee development and flexible assignments to ensure business needs are met.

What you must have:

• High School diploma or GED

• One year experience in a customer service role with performance metrics

• Experience using Microsoft Office products and the Internet

• Healthcare industry experience to include knowledge of health services

• Contact center experience to include call center chat messaging

• Military experience focusing on service delivery