Call Center Representative

Position Overview

Customer Service Representatives (CSRs) are responsible for providing comprehensive high-quality service to all customers. The primary responsibilities include, but are not limited to, answering customer calls, proactively working to resolve our members and providers questions and concerns, responding to and documenting all customer encounters, intaking complaints, conducting outreach and retention efforts, assisting with Primary Care Provider (PCP) selections and handling all provider inquiries related to eligibility, claims and authorizations.

• Strive for first call resolution, working to resolve member and provider issues as the point of contact.
• Utilize dual monitors and leverage computer-based resources to find answers to customer questions.
• Research and respond accurately to all customer inquiries related to eligibility, benefits/services, claims and authorizations.
• Classify and record all customer encounters clearly and concisely.
• Identify and intake customer complaints capturing all pertinent information.
• Assist members with PCP selection, as well as locating providers and vendors within plan’s network.
• Verify and update member demographic information.
• Process requests for member materials, such as , member guide, provider directory, etc.
• Handle enrollment inquiries and generate sales leads.
• Handle disenrollment requests and proactively conduct retention efforts.
• Perform outreach related to New Member Orientation and PCP term/reassign projects.
• Process premium payments.
• All other duties and special projects as assigned by the Director of Customer Service.
• Ability to work between 8:00 AM and 6:00 PM Monday - Friday, and 9:00 AM-5:00 PM Saturday.
• Training class (Paid): 9:00 AM-5:00 PM Monday-Friday.

• High School graduation or evidence of having satisfactorily passed a High School Equivalency Program.
• Minimum 1 year experience in a call center environment, or
• A satisfactory equivalent combination of education, training, and experience.
• Managed care experience preferred.
  
  Proven experience providing excellent service to customers in various healthcare related areas (i.e., insurance, doctor’s office, medical clinics).
• Poise under pressure when dealing with difficult situations and potentially upset customers.
• Ability to work in a fast-paced environment while keeping a high attention to detail.

• Integrity and Trust
• Customer Focus
• Functional/Technical Skills
• Written/Oral Communication