Customer Services Specialist

Job Summary:

This position has the following primary objectives with respect to customer relations for all HAP product lines: (1) Provide follow-up and courteous and prompt resolution to member inquiries by conducting thorough investigations and fully educating members and customers; (2) Support corporate and departmental goals, member enrollment activities and product implementations; (3) Research, investigate and resolve service failures. Improve the customer experience by identifying root causes, trends and recommend resolutions for service recovery and retention;

(4) Educate members and prospective members to promote HAP as the health care coverage of choice.

Duties and Responsibilities:

-Respond to inquiries by telephone, mail and in person; research and answer inquiries, complaints and appeals by following all department standards, policies and procedures; direct inquiries to supporting departments for appropriate action and resolution.

-Educate existing and potential members on policies, procedures, product offerings, benefit plan and coverage provisions related to all HAP products.

-Document all incoming inquiries accurately in to track member inquiry history and trends.

-Practice and maintain confidentiality to Privacy and HIPAA regulations.

-Proactively seek training and development to enhance skills and abilities.

-Monitor workflow inbox and outstanding cases to ensure that all inquiries receive an appropriate response in a timely manner; contact members (by phone/or in writing), as needed, to ensure timely resolution and follow-up to inquiry.

-Interact with support departments in a professional manner to ensure member needs are met.

-Develop and maintain strong business relationships with inter-departments; continue to self-educate on changes in policies and procedures that occur in other departments which could have an impact on department operations and the servicing of member/customers.

-Attend training and development sessions or continuing education opportunities offered by Customer Service and maintain enhanced skill levels and performance.

-Interact with providers and their staff to obtain information for resolving customer inquiries and complaints.

-Ensure and maintain compliance of all department and corporate standards, policies and procedures.

-Recommend process improvements based on observations and trends identified while interacting with internal and external customers.

-Coordinate and assist with various departmental projects, member enrollment periods, outreach activities and corporate initiatives.

-Perform other related duties as assigned.

Required

Skills & Experience:

-Minimum of two (2) years of recent Customer Service or Call Center experience within the last three years.

-Must be dependable.

-Demonstrate a high degree of integrity, patience, maturity, empathy, tact and Diplomacy.

-Demonstrate problem solving skills, flexibility, good judgment and ability to provide service excellence.

-Demonstrate the ability to handle assigned projects from start to successful completion including appropriate follow-up and documentation.

-Demonstrate the ability to handle multiple priorities concurrently in a timely and accurate manner.

-Demonstrate strong interpersonal, listening, verbal communication and business writing skills.

-Demonstrate efficiency in using a PC and various Microsoft programs.

-Fundamental understanding of HMO/PPO/POS delivery system and claims billing.

-Must be able to work flexible shifts, overtime including evenings and weekends as requested and/or scheduled. Preferred

Skills & Experience:

-N/A