Customer Service Representative

We are a Colorado-based company, working to improve the health of our state. We care for individuals, families, and children who receive health care under Child Health Plan Plus (CHP+) and Health First Colorado (Colorado's Medicaid Program). Our focus is driving improvements in quality, member experience, outcomes, and cost. We are a mission-driven organization whose foundation is built by our vision and supported by our values.

We are looking for a CUSTOMER SERVICE REPRESENTATIVE I who can help shape our vision and support our mission.
Bilingual in Spanish/English is highly preferred. Here is what the position will look like.

• Answer incoming calls with a customer-focused approach while maintaining professionalism and courtesy at all times.
• Maintain full availability during scheduled shifts, remaining accessible throughout the workday to ensure timely service.
• Research, resolve, and document customer inquiries, concerns, and issues accurately and efficiently.
• Provide clear and accurate information and education related to benefits, coverage, policies, claims, and general inquiries.
• Utilize available resources such as policies, procedures, training materials, handouts, databases, and multiple systems to complete daily work.
• Document all interactions clearly and thoroughly in the E-Plus system or other required systems.
• Conduct outbound calls for follow-ups, benefits information, claims clarification, and other customer-related needs as assigned.
• Respond to email inquiries sent to the Customer Service inbox in a professional, clear, and HIPAA-compliant manner when assigned.
• Assist members with basic policy updates such as contact information changes and general account questions.
• Provide general guidance on how to file claims and what documentation is required.
• Follow a daily schedule for breaks and lunches as assigned.
• Maintain regular attendance and punctuality as an essential function of the role.
• Consistently meet or exceed performance, quality, and customer service standards set by department leadership.

High school diploma or equivalent required.

Minimum of 2 years’ customer service experience is required. Experience in medical insurance and Medicare and Medicaid eligibility and enrollment is highly preferred.
Bilingual in Spanish/English is highly preferred.

Ability to work within a call center environment and answer inquiries in a professional manner. Requires the ability to identify and appropriately handle grievances and appeals, and to facilitate quality outcomes and/or resolutions for the benefit of all applicable parties. Demonstrates support for the company’s mission, vision and values. Position requires excellent written and verbal communication skills. Must be proficient in Microsoft office applications (Word, Excel, PowerPoint, Outlook, SharePoint) with ability to work with a variety of project management tools.

May be required to manage multiple priorities and projects with tight deadlines.