Our client managed health-care company that provides health care for many Texans and serves members in all 254 counties across the state.
As a Customer Service Representative I, you will be empowered in educating our Members by answering
questions and solving member inquiries via telephone and written correspondence.
• Document all activities for reporting and resolution through the customer relationship management application (CRM)
• Answer inquiries from members regarding eligibility, product/covered benefits, value added services, authorization status issues, etc.
• Provide first call resolution through issue documentation and resolution with appropriate internal
resource, follow-up and ensure closure with the contact who initiated the inquiry
• Respond appropriately to member issues and concerns, and provide trending feedback to improve the customer experience
• Intake Member Complaints/Grievances/Appeals
• Process customer correspondence and provide the appropriate level of timely follow up
• Manage service related follow up items and outstanding tasks in accordance with established turn around times
• Provide assistance to members regarding Secured Web
Portal regarding website registration, navigation and customer related inquires
• Maintain performance and quality standards based on established call experience guidelines
• Identify any trends related to incoming or outgoing calls that may provide policy or process improvements to support excellent customer service , quality improvement and call reduction
• High School Diploma or GED;
• Proficiency in MS Office
• Strong attention to detail
• Excellent written and verbal communication skills
Process Improvements (Business)
Customer Relationship Management