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Job Description
Essential Responsibilities:
Available to handle member inquiries regarding:
- Member Services: Facility Inquiry, Web Support, Order ID Card, Complaint, ID Card Inquiry, Service Review, Eligibility Inquiry, Benefit Inquiry, General, Complaint, Correspondence Inquiry, Add/Remove Dependent, Service Review, New Member Experience, Internal Regional Request, IVR Defaults.
- Medicare
- Billing: Billing Inquiry, Make Payment, Complaint, EFT Inquiry, General, Reinstatement Request, Service Review, 1095 Tax Form.
- Represents Health Plan by answering and documenting all incoming contacts to determine their nature and to respond to complex calls related to specialized product lines or queues.
- Responds professionally to inquiries from internal/external customers. Promotes, ensures and provides customer service to internal/external customers by demonstrating skills which are consistent with the organization's philosophy of providing extraordinary customer relations and quality service.
- Initiates contact with the appropriate Health Plan, medical group and facility personnel to obtain information relevant to the concern or inquiry as needed.
- Evaluates data to determine and implement the appropriate course of action to resolve the complaint and/or coordinate service recovery.
- Documents conversations with members according to the procedure.
- Follows established procedures to meet customer/member needs.
- Has a substantial understanding of the assigned skills and applies knowledge and skills to complete a wide range of tasks.
- Ability to understand relevant policies, processes and customers.
- Assist the department in meeting customer needs and reaching department expectations.
- Completes required training and understand how to use tools available to recall necessary information.
- Develop a full awareness of the way performance and actions affect members and Member Service.
- Maintains Contact Center performance KPIs for call handling, first call resolution, complaint resolution compliance, member retention, and return contact as warranted.
- Consistently supports compliance and the Code of Conduct by maintaining the privacy and confidentiality of information, and protecting the assets of the organization.
Preferred Qualifications:
• Call center experience preferred.
• Health insurance experience preferred
Basic Qualifications:
Experience
• Minimum two (2) years of customer service experience or healthcare member-interacting experience required
• High School Diploma or General Education Development (GED) required.
Additional Requirements:
• Excellent written and verbal communication skills.
• Demonstrated analytical and problem-solving skills.
• Ability to read and respond briefly, clearly and effectively.
• Ability to think critically and problem-solve.
• Typing test - 30 wpm with a 5% or less error rate
• Must successfully pass knowledge checks while in training.