CUSTOMER SERVICE REPRESENTATIVE

Job Summary:

The Customer Service Representative is responsible for answering customer service calls from providers and members. This includes providing information, resolution, and assistance to callers. The Customer Service Representative acts as “first impression” person representing employer to visitors and callers. In addition to providing clerical assistance to all departments as directed by UM Support Services Director.

Responsibilities:

• Provides a full range of assistance to provider and members or their representatives via telephone or correspondence concerning eligibility, selection of primary care physicians and claims.
• Answers telephone in a prompt, professional, courteous and helpful manner; screens and directs calls to appropriate staff member/department. Responds to routine requests for information. 
• Makes outbound calls to set up patient appointments with the members PCP or a Specialist after a hospital admission. 
• Process online external communication throughout (CS Tickets) the day between calls. 
• Prepares, prints, and distributes variety of system-generated reports/letters on schedule, using report software. (Includes: -0- net explanation of benefits, acknowledgement letters, authorization letters, and customer service reports).
• Interviews provider and members or their representatives to determine the nature of their problem or interest. Explains technical provisions and elicits relevant facts. Documents and investigates provider and member complaints and reconciles discrepancies. Pursues to completion incidents of dissatisfaction.
• Responsible to maintain and log accurate phone calls in the Customer Service module in Portal. Demonstrates a comprehensive knowledge of Health Plan Benefits and the various departmental functions.  
• Analyze and identify concerns/issues and refer to appropriate department if deemed necessary. 
• Investigates and resolves systems-identified discrepancies and situations. 
• Performs a variety of routine clerical functions as assigned to include, but not limited to, filing, photocopying, proofreading and verifying documents for accuracy and completeness. Prepares standard forms and routine reports. Compiles simple data, resolving or rejecting errors and omissions.
• Performs related duties consistent with the scope and intent of the position.
• Regular attendance.
• Travel as required.

Other Functions

• Enforces Company policies and safety procedures.
• Regularly updates job knowledge by participating in educational opportunities, reading professional publications, maintaining professional networks, and participating in professional organizations.
• Maintain IPA, Health Plan compliance standards.

Competencies

• One (1) year of customer service-related experience required.
• HMO/IPA experience preferred.
• Ability to consistently deliver excellent customer service.
• Strong oral and written communication skills, with the ability to communicate professionally with diverse individuals and groups inside and outside of Vivant.
• Excellent active listening skills.
• Ability to demonstrate compassion and sensitivity to patients’ needs and concerns.
• Ability to consistently deliver excellent customer service.
• Ability to demonstrate professionalism, confidence, and sincerity in a diverse work culture
• Ability to exercise sound discretion and strict maintenance of confidentiality of all confidential and sensitive communications and information.
• Ability to solve entry to mid-level problems with minimal supervision.
• Ability to multi-task, exercise excellent time management, and meet multiple deadlines.
• Ability to provide and receive constructive job and/or industry related feedback.
• Excellent attention to detail and ability to document information accurately.
• Ability to effectively and positively work in a dynamic, fast-paced team environment and achieve objectives.
• Demonstrate commitment to the organization’s mission.
• Must have mid-level skills in MS Word/Excel.
• Must have the ability to quickly learn and use new software tools.
• Must have mid-level skills using e-mail applications.
• Self-motivated with strong organizational, multi-tasking, planning, and follow up skills.
• Ability to work independently as well as in a team environment.
• Ability to present self in a professional manner and represent the Company image.

Education and Licensure

• High School Diploma or GED minimum requirement.
• Associate degree in a related field preferred.

Travel

• The incumbent may travel up to 5% of the time.

Work Environment

This job operates in a professional office environment. This role routinely uses office equipment such as computers, phones, photocopiers, scanners and filing cabinets.