Customer Service Representative I - LBS

Job Description

The Customer Service Representative resolves customer inquiries via telephone, fax, off-phone work, and email concerning, but not limited to, account benefits, claim payments, and enrollment in accordance with Operational Risk Audit (ORA), HIPAA, and other legislative requirements. This role requires participation in training immediately upon hire to become proficient in one line of business to independently perform the duties outlined below.

Training in the second line of business must be initiated and completed within 12 months of proficiency in the first line of business to cross-functionally support the department. Initial line of business will be determined by the area of greatest need at time of hire.

The Customer Service Representative resolves customer inquiries via telephone, fax, off-phone work, and email concerning, but not limited to, account benefits, claim payments, and enrollment in accordance with Operational Risk Audit (ORA), HIPAA, and other legislative requirements. This role requires participation in training immediately upon hire to become proficient in one line of business to independently perform the duties outlined below.

Training in the second line of business must be initiated and completed within 12 months of proficiency in the first line of business to cross-functionally support the department. Initial line of business will be determined by the area of greatest need at time of hire.

• Researches, documents, interprets, and responds to inquiries from internal and external customers, business partners, and special groups concerning our products, services, and policies in accordance with ORA, HIPAA, and other legislative requirements.
• Researches and responds to questions related to claims, onboarding, effectuation, retention, provider inquiries, and any other complex inquiry. Identifies and follows through on issues impacting the Health Plan and customer experience.
• Provides service to customers and business partners while responding in a professional, efficient, and timely manner to enhance member and provider satisfaction and retention. Must exercise tact, patience, and professionalism at all times in responding to internal/external customers.
• Utilizes appropriate resources to resolve customer inquiries accurately & efficiently, resulting in acceptable quality, First Call Resolution, and performance.
• Develops effective internal working relationships for improved communication and collaboration.
• Shares ideas and solutions to improve processes, procedures, and systems.
• Participates in meetings, training, and skill development to support career path and individual development plans.
• Consistently demonstrates high standards of integrity by supporting the Lifetime Healthcare Companies’ mission and values, adhering to the Corporate Code of Conduct, and leading to the Lifetime Way values and beliefs.
• Maintains high regard for member privacy in accordance with the corporate privacy policies and procedures.
• Regular and reliable attendance is expected and required.
• Performs other functions as assigned by management.

• Provides expertise, daily support, mentoring, coaching, and guidance to other advocates.
• Assists with job shadowing and new employee training for multiple lines of business.

NOTE:

We include multiple levels of classification differentiated by demonstrated knowledge, skills, and the ability to manage increasingly independent and/or complex assignments, broader responsibility, additional decision making, and in some cases, becoming a resource to others. In addition to using this differentiated approach to place new hires, it also provides guideposts for employee development and promotional opportunities.

• High School diploma or equivalent. Customer service experience preferred.
• Strong communication skills across multiple channels including, but not limited to, voicemail, email, outbound calls, etc. Adept at communicating effectively and diplomatically while working as a collaborative team member.
• Strong organizational skills and ability to…