Customer Service Representative

Overview

The Customer Service Representative I handles calls from customers to resolve, educate, follow up, and respond to questions regarding California Choice/Choice Builder plan administration and procedures for groups, members, brokers, and general agencies.

• Understand company policies and procedures as they apply to California Choice/Choice Builder plans.
• Answer questions by telephone from groups regarding new hires, billings, rates, supplies, administrative procedures, etc.
• Educate, via telephone, employees/dependents regarding PCPs, , RX problems, administrative procedures, dependent coverage, address changes, etc.
• Follow up on calls and emails from brokers regarding problems that their groups are experiencing with providers.
• Interact with brokers, general agents and sales representatives on a daily basis and answer questions regarding California Choice processes.
• Respond to calls from providers to confirm eligibility and benefits.
• Verify enrollments and resolve issues with carriers.
• Expedite the processing of members' enrollment with the carrier if urgent services are needed.
• Review and submit appeal requests from groups.
• Review/audit group billing and explain to clients in a clear and accurate manner.
• Document calls in the call tracking system.
• Maintain departmental standards for service quality, including targets such as call review scores and call handling metrics as defined by the department.
• Adhere to all HIPAA (Health Insurance Portability and Accountability Act) and PHI (Personal Health Information) guidelines.
• On-site regular attendance and punctuality are essential functions of the job.
• Perform other business tasks or functions as assigned.

• At least two (2) years of customer service experience preferred.
• Knowledge of the health insurance industry and customer service experience preferred.
• Ability to handle irate customers in a courteous, patient, calm, and positive manner while maintaining a high quality and quantity of work.
• Experience in handling high call volume.
• CA Life & Health license required. If a successful applicant does not have an insurance license, it is required to obtain one within six (6) months of the date of hire.
• Excellent verbal and written communication skills, especially under pressure.
• Computer literate in Microsoft Word, Excel, and Outlook. Accurate data entry skills are a must. Typing at 55 WPM or more.
• Ability to work in a fast-paced environment where deadlines are a priority and handle multiple assignments simultaneously.
• Problem-solving skills required.
• Proficient knowledge of the English language. Proficient knowledge of the Spanish language is a plus. If hired as a Bilingual representative, Language Assistance Certification is required every two (2) years.

• High school diploma or equivalent required.

Must be able to sit for extended periods of time and occasional standing and walking. Must have adequate hearing for phone work. Vision requirements include close vision and the ability to adjust focus. Must be able to communicate effectively in English. Must be able to use a keyboard and other office equipment. Ability to lift up to 10 pounds occasionally.