Customer Service Rep PH

Customer Service Representative

Assist and educate members, employer groups, providers, colleagues, and/or elite agents of health plan benefits with accessing services, facilitating and resolving complex problems, understanding claims, billing and coding, along with other non-routine questions. Consistently create an exceptional experience with each contact, via inbound and outbound calls, online chat, email, etc.

Essential Functions

• Demonstrates high competency in analyzing, evaluating, and responding to complex service inquires from members, providers, employer groups, colleagues, agents, Elite agents, and different customer types across multiple Priority Health products within departmental guidelines. Professional and pleasant interactions are ongoing expectations.
• Partnering with internal and external resources, promptly provides customers with information and education concerning benefit clarification, eligibility requirements, verification, authorization, billing and claim status.
• Promptly identifies and resolves or escalates customer concerns or complaints to achieve positive outcomes. Places outbound welcome calls to members to educate them on their benefits as needed. Assists walk-in members and agents if assigned by leadership.
• Adheres to established procedure and quality guidelines in support of Priority Health service promise, key drivers, performance indicators, as well as Corporate values and codes of excellence. Identifies potential trends or issues that impact health plan members and works with coworkers and leadership resources to suggest process improvements.
• Assists customers with administrative issues, such as submitting enrollment record changes, providing letter explaining coverage or benefits, and obtaining and relaying certain member information to other departments as needed.
• Facilitates claims resolution through follow-up on member calls and correspondence received to appropriate departments.
• Effectively tracks and/or documents all service interactions with customers within appropriate systems according to guidelines.
• Develops and maintains behaviors of productivity, availability to customers, and adherence to work schedule.

Qualifications

Required

• High School Diploma or equivalent
• 2 years of relevant experience customer-facing service on phone or face to face; customer service, high volume call center, medical billing, insurance environment relevant to benefits, provider contracting, claims processing, and/or managed health care

Preferred

• Associate's Degree

About Corewell Health

As a team member at Corewell Health, you will play an essential role in delivering personalized health care to our patients, members and our communities. We are committed to cultivating and investing in YOU. Our top-notch teams are comprised of collaborators, leaders and innovators that continue to build on one shared mission statement - to improve health, instill humanity and inspire hope.

Join a nationally recognized health system with an ambitious vision of continued advancement and excellence

• Comprehensive benefits package to meet your financial, health, and work/life balance goals
• On-demand pay program powered by Payactiv
• Discounts directory with deals on the things that matter to you, like restaurants, phone plans, spas, and more!
• Optional identity theft protection, home and auto insurance
• Traditional and Roth retirement options with service contribution and match savings
• Eligibility for benefits is determined by employment type and status

Primary Location

SITE - 1700 Magnavox Way Suite 201 - Fort Wayne

Department Name

Physicians Health Plan of Northern Indiana Admin - PH Managed Benefits

Employment Type

Full time

Shift

Day (United States of America)

Weekly Scheduled Hours

40

Hours of Work

8 a.m. to 5:00 p.m.

Days Worked

Monday to Friday

Weekend Frequency

N/A