Position: Customer Service Representative
Reports to: Customer Service Manager
Position Type: Full Time, Non- Exempt
Office Location: Madison, WI
The Customer Service Representative is responsible for providing an exemplary level of customer service and telephone support for current and prospective providers and members, and for ensuring accurate resolution of inquiries. This position is the organization’s front-line, primary customer service representative and provides incoming communications support as well as coordination for resolution with other departments. Customers may include providers, members, internal staff, and other stakeholders.
- Answer incoming calls and provide inquiry resolution based on procedures, scripts, and other training materials. Inquiries include but are not limited to billing, eligibility, enrollment, provider network, program benefits, and appeals/grievances. Calls may be triaged to appropriate individuals/department as protocols indicate. Must maintain accurate, detailed and well-documented logs of every call.
- Receive and route prior authorizations according to established processes, including entry of authorization requests into the appropriate systems.
- Ensures call resolution and completion by working collaboratively with multiple departments for problem resolution as applicable.
- Responds within established timeframes to inquiries from members and providers.
- Provides support for other departments, including but not limited to such activities as placing outbound reminder or educational calls, intake of written and phone RSVPs for provider and community events, processing of in or outbound correspondence, and other duties as assigned.
- Provides back up coverage for Receptionist as assigned.
- Demonstrated strong communication skills, both verbal and written.
- Ability to make decisions based on set guidelines and parameters.
- Ability to develop and maintain effective relationships and provide outstanding customer service internally and externally.
- Ability to work effectively in a team environment.
- Ability to evaluate processes and procedures for continuous process improvement.
- Ability to adapt to and work effectively in a fast-paced and changing environment with multiple priorities.
- Ability to effectively navigate within multiple applications, intermediate skill with internet and MS Office Suite
- Proficiency in keyboarding, word processing, and data entry is required
EDUCATION & EXPERIENCE
- High School diploma/GED is required
- Two years of experience with administrative, reception or call center experience (preferably in a health care setting)
Monday-Friday, 8am-4:30pm; 40 hours per week
- Paid Time Off/ Paid Holidays