As a Customer Service Representative you will: directly respond to questions, handle issues and provide guidance on transactions, inquiries or complaints from both internal and external customers. External customers would include members and providers. Receive, document and resolve customer inquiries by using established best practices. Build lasting relationships with client members. Educate members and providers about products and services over the telephone.
Role and Responsibilities:
Respond to complex customer calls.
Resolve customer service inquiries which could include: Benefit and Eligibility information; Billing and Payment issues; Customer material requests; Physician assignments; Authorization for treatment; and Explanation of Benefits (EOB)
Must be able to handle volatile situations and act urgently when necessary.
Must be willing and able to work flexible hours, including some weekends during specific times of the year and over time when needed.
Makes outbound calls to any source needed to resolve open issues including but not limited to members, providers, pharmacies, hospitals etc.
Issue form letters & forms, when appropriate.
Investigates and respond to general correspondence, which may result in a variety of additional actions.
Must have strong investigative, problem solving skills.
Must be very detailed oriented and organized.
Ability to read and comprehend instructions in a very changing environment.
Ability to interact with other department’s i.e. Enrollment, medical management in resolving issues.
Familiarity with computer and Windows PC applications, which includes the ability to learn new and complex computer system applications.
Experience, Qualifications and Education:
High school diploma or general education degree (GED).
Minimum of 2 years HealthCare/insurance experience.
Proficiency in all Microsoft Office Programs, including Word, PowerPoint, Excel, and Access.
Ability to type 30-45 wpm.
Prior Customer Service & Claims adjudication experience in the healthcare field along with working knowledge.
Help us improve CareerBuilder by providing feedback about this job:
Report this job
Report this Job
Once a job has been reported, we will investigate it further. If you require a response, submit your question or concern to ourTrust and Site Security Team
privacy and protection,
when applying to a job online, never give your social security number to a prospective employer, provide credit card or bank account information, or perform any sort of monetary transaction.Learn more.
By applying to a job using CareerBuilder you are agreeing to comply with and be subject to the CareerBuilder
Terms and Conditions
for use of our website. To use our website, you must agree with the
Terms and Conditions
and both meet and comply with their provisions.