Description:
Responds to member and provider inquiries (phone, written or walk in) regarding all aspects of our client’s business, including claims, in a professional, timely, accurate and caring manner while consistently meeting all guidelines.
Key Duties and Responsibilities:
- Responds to member, provider and other inquiries via telephone, correspondence or lobby walk-in while meeting all corporate guidelines and performance standards
- Demonstrates appropriate customer-care skills such as empathy, active listening, courtesy, politeness, helpfulness and other skills as identified
- Records, investigates and resolves member complaints as detailed in the Grievance Procedure narrative
- Assists in the education of new members and in the re-education of existing members regarding health plan procedures
- Logs, tracks and appropriately documents all issues utilizing on-line systems and procedures, and in accordance with all applicable guidelines and requirements
- Makes decisions that are consistent with the concept of a win-win-win for members, associates and our client
- Demonstrates based behaviors such as initiative, accountability and value
- Performs skills necessary to create a high-quality customer experience, as reflected through acceptable C-Sat scores, quality monitors and member feedback
- Performs other duties as assigned
Education:
- A High School or GED or equivalent work experience
Work Experience:
- 6 months of experience in relevant work
- Previous experience in a call center or customer service environment
Licenses and Certifications:
- Customer service, quality or training certifications
Skills:
- Demonstrated written communication skills
- Demonstrated interpersonal/verbal communication skills
- Ability to multi-task, good organizational and time management skills
- Demonstrated organizational skills
- Demonstrated time management and priority setting skills
- Ability to effectively present information and respond to questions from peers and management
- Ability to create, review and interpret treatment plans
- Ability to act on feedback provided by showing ownership of his or her own development
- Ability to read, analyze, and interpret verbal and written instructions
- Seeks to build trust, respect and credibility with all partners through full, honest, consistent, and coordinated communication
- Ability to define problems, collect data, establish facts and draw valid conclusions
Technology:
- Microsoft Outlook
- Microsoft Word
- Microsoft Excel
Level of Supervision Received:
- Under general supervision, proceeds alone on regular duties, referring questionable cases to supervisor