Job Description - Customer Service Representative
Provide excellent customer service primarily by telephone to all customers. Assist customers with coverage/claims related questions. Accurately interpret benefits and policy provisions for all products. Conduct appropriate research and follow-up for prompt resolution of disputed claims.
**Temp to hire opportunity!**
Essential Responsibilities:
- Work efficiently in a high volume call center while maintaining a professional, positive, and caring demeanor.
- Assist callers with coverage related questions/concerns; accurately interpret policy provisions for assigned products.
- Analyze customer’s inquiries and determine correct steps for resolution, interpret benefit information, and claims processing accuracy. Keep resource information up to date and well organized.
- Work efficiently in multiple systems simultaneously while effectively utilizing critical thinking and problem solving skills.
- Document calls in a clear and consistent manner in computer system.
- Conduct appropriate research, take ownership and follow through for prompt resolution of disputed claims.
- Relay information to appropriate departments and personnel using established communication channels and procedures.
- Make outbound calls to members as necessary dependent upon current outreach campaign.
Supporting Responsibilities:
- Meet department and company performance and attendance expectations.
- Be aligned with company values.
- Follow the privacy policy and HIPAA laws and regulations concerning confidentiality and security of protected health information.
- Perform other duties as assigned.
SUCCESS PROFILE
Work Experience: One-year medical insurance, other healthcare related field, call center or customer service experience required. CPT/ICD-10 coding preferred.
Education, Certificates, Licenses: High School Diploma or equivalent required.
Knowledge: Basic understanding of insurance and medical terminology, coding and standard medical billing practices preferred. Proficient computer skills, typing, and 10-key required. Strong written and verbal communication skills.
