Position - Healthcare Customer Service Representative
Address - San Jose, CA 95119
Hours – 8am -5pm (M-F)
Pay – $18/hr
Start Date – Asap
- 2 years of healthcare customer service experience
This role is open for due to a project that they need completed. This person will be making outbound calls to members and having the members complete a survey
- Act as the primary point of contact and liaison for members and providers contacting the plan regarding general inquiries, concerns or requests for information.
- Develop a general understanding of all member facing materials, communications and interactions and be prepared to respond appropriately to follow up calls.
- Answer inbound calls and/or place outbound calls in a high call volume environment and work directly with members and providers to accurately and completely answer inquiries involving program services and benefits.
- Follow established guidelines and resources to respond to member and provider inquiries and resolve concerns in an accurate, timely, professional, and culturally competent manner.
- Intake, handle and coordinate member grievances, appeals and billing issues, escalating to the Grievance and Appeals department, when necessary.
- Educate members and providers on eligibility, and medical and pharmacy benefits and how to access services in a manner that achieves excellent service standards and maintains high customer satisfaction.
- Use listening skills and judgment to appropriately categorize and accurately document all contacts and follow-up actions regarding member and provider communications and activities in accordance with established guidelines.
- Appropriately handle member and provider requests through alternative channels such as e-mail, voicemail, fax, walk-in, etc. in accordance with established procedures.
- Triage member and provider requests or inquiries for other departments.
- Conduct member surveys as assigned in accordance with established guidelines.
- Attend and actively participate in daily, weekly, and monthly departmental meetings, in-services, training and coaching sessions.
- Identify member/provider issues and trends and report relevant information to management.
- Perform other related duties as required or assigned.