Customer Service Representative

Role and Responsibilities:

• Respond to customer calls accurately and professionally demonstrating a genuine delight to serve
• Resolve customer service inquiries which could include:
• Benefit and Eligibility information
• Billing and Payment issues
• Customer material requests
• Physician assignments
• Authorization for treatment
• Explanation of Benefits (EOB)
• Handle escalated situations and act urgently when necessary
• Make outbound calls to any source needed including but not limited to members, providers, pharmacies, hospitals etc. to resolve issues
• Issue form letters & forms when appropriate
• Investigate and respond to general and complex inquiries and document in the system as appropriate
• Interact with other departments including Enrollment and Medical Management to resolve issues
• Adhere to compliance requirements and CMS standards
• Willing and able to work flexible hours including weekends during part of the year as well as overtime when needed

Experience, Qualifications and Education:

• High school diploma or equivalent and at least 1 year of related experience with the demonstrated ability to perform the responsibilities outlined in the Job Description
• Familiarity with computer and Windows PC applications and the ability to learn new and complex computer system applications
• Working knowledge of Microsoft Outlook, Word, Excel and Power Point
• Excellent verbal communication skills including the ability to clearly and professionally speak to associates and customers at all levels
• Detailed oriented and organized
• Strong investigative and problem-solving skills
• Able to read, comprehend and accurately follow instructions in a constantly changing environment
• Able to type 30-45 wpm
• Prior health care or insurance experience preferred