Apex Systems is looking for a qualified Customer Service Representative for one of our large healthcare clients in Denver, CO! If you are interested, please apply with your resume along with job reference #1025179.
The Customer Service Representative is responsible for increasing customer satisfaction and retention by providing members, customers, patients and providers with accurate, consistent, timely and meaningful information. They will provide support to member inquiries and issues as they utilize the client's plan and provider services, continuing to build rapport and collaborative relationships with current and prospective members in accordance with compliance guidelines.
Major Responsibilities / Essential Functions:
• Represents health plan by answering and documenting all incoming contacts to determine their nature and to respond to complex calls related to specialized product lines or queues
• Responds professionally to inquiries from internal/external customers
• Initiates contact with the appropriate health plan, medical group and facility personnel to obtain information relevant to the concern or inquiry as needed.
• Evaluated data to determine and implement the appropriate course of action to resolve the complaint and/or coordinate service recovery
• Documents according to procedure
• Follows established procedures to meet customer/member needs
• Required to effectively interact with diverse work units and relevant organizational departments
• Has substantial understanding of the assigned skills and applies knowledge and skills to complete a wide range of tasks
• Ability to understand relevant policies, processes and customers
• Assist the department in meeting customer needs and reaching department expectations
• Completes required training and understand how to use tools available to recall necessary information
• Develop a full awareness of the way performance and actions affect members and Member Service Contact Center’s performance guidelines (call handling, first call resolution, complaint resolution compliance, member retention and return contact as warranted)
• Promotes, ensures and provides customer service to internal/eternal customers by demonstrating skills which are consistent with the organization’s philosophy of providing extraordinary customer relations and quality service
• Consistently supports compliance and the principles of responsibility of the client's Code of Conduct by maintaining the privacy and confidentiality of information, and protecting the assets of the organization.
• Performs other relevant duties as required.
Available to handle member inquiries regarding:
• Member core: facility inquiry, web support, promote the website, order ID card, complaint, ID Card inquiry, service review.
• Member advantage: eligibility inquiry, benefit inquiry, general, complaint, correspondence inquiry, add/remove dependent, service review, new member experience, internal regional request, IVR defaults
• Medicare for up to two (2) regions
• Premium billing enterprise: billing inquiry, make payment, complaint, EFT inquiry, general, reinstatement request, service review
• Billing: 1095 tax form, SLP
Minimum Work Experience and Qualifications:
• High School Diploma or equivalent
• Two (2) years of customer service experience required
• Must pass an online assessment
• Excellent written and verbal communication skills
• Demonstrated analytical and problem-solving skills
• Ability to read and respond briefly, clearly and effectively
• Ability to think critically and problem solve
Preferred Work Experience and Qualifications:
• Call center experience
• Health insurance experience
Apex Systems is an equal opportunity employer. We do not discriminate or allow discrimination on the basis of race, color, religion, creed, sex (including pregnancy, childbirth, breastfeeding, or related medical conditions), age, sexual orientation, gender identity, national origin, ancestry, citizenship, genetic information, registered domestic partner status, marital status, disability, status as a crime victim, protected veteran status, political affiliation, union membership, or any other characteristic protected by law. Apex will consider qualified applicants with criminal histories in a manner consistent with the requirements of applicable law. If you have visited our website in search of information on employment opportunities or to apply for a position, and you require an accommodation in using our website for a search or application, please contact our Employee Services Department at 844-463-6178
Customer Relationship Management