Description:

Our client is a medical equipment company searching for a dedicated Customer Service Representative to join our team. In this role, you will be responsible for processing member complaints and handling identification card requests. Your primary goal will be to ensure member satisfaction through professional, courteous, and efficient service.

Responsibilities and Duties:

• Handle telephone, written, and in-person inquiries in a courteous, professional, thorough, and timely manner to assure member satisfaction.
• Provide quality services effectively to increase the overall level of customer service and satisfaction as measured by CMS.
• Identify the differences between a Grievance, Appeal, or Coverage Decision and process the request through the appropriate channels.
• Identify, handle, document, and/or route Utilization Management inquiries appropriately.
• Record all inquiries and complaints.
• Manage time effectively and prioritize tasks to meet deadlines.
• Be attentive to the caller's needs, and respond quickly and competently to requests.
• Comply with company policies and procedures and maintain confidentiality of customer medical records in accordance with state and federal laws.
• Ensure compliance with all HIPAA, OSHA, and other federal, state, and local regulations.
• Assist customers, family members, and others with concern and empathy; show respect in all interactions.

Qualifications:

• Minimum of a High School diploma
• 2 years of call center experience preferably in healthcare
• Excellent communication skills and attention to detail
• Bilingual (in English and Spanish)
• 2 years of Medicare Advantage Plan customer service experience