Call Center Member Service Representative

About the role

Our Customer/Member Services Representatives are one of the most important pillars to our success, directly interfacing with our valuable members. We’re looking for top-tier talent who takes ownership in creating a successful journey for our clients. This is a challenging role that requires an emphasis on customer centricity, high energy, and work with the highest purpose of customer satisfaction and retention.

Responsibilities

• Answering phones from members professionally and responding to member inquiries and complaints
• Handle escalated calls, resolving more complex member issues in First Call Resolution (FCR)
• Demonstrate outstanding service to identify the source of the issue and work to resolve member inquiries and issues in a timely and professional manner, related to benefits, eligibility and claims, financial spending accounts, and correspondence
• Research complex issues across multiple databases and work with support resources to resolve customer issues and/or partner with others to resolve escalated issues
• Responsible for knowing all aspects of health program benefits including medical and pharmacy
• Required to be at workstation to answer calls in an ACD environment, subject to the monitoring of incoming and outgoing ACD calls for quality assurance during scheduled work periods
• Identifying, escalating priority issues, and reporting to high-level management
• Responsible for taking issues on a weekly basis to the department manager
• Obtaining and evaluating all relevant data to handle complaints and inquiries
• Handling outbound and inbound calls from external and internal customers
• Completing call reports, logs, and researching billing issues
• Recognizing, documenting, and informing the supervisor regarding trends in internal and external customer calls

Requirements

• High School Diploma/GED (or higher)
• 6+ months of Call/Contact Center experience
• 6+ months of Customer Service experience analyzing and solving customer problems

Preferred Qualifications

• Healthcare or Insurance Call/Contact Center experience
• Ability to create, modify, and send documents, spreadsheets, and emails in Microsoft Excel, Word, and Outlook
• Demonstrated ability to quickly build rapport and respond to customers in a compassionate manner by identifying and exceeding customer expectations
• Demonstrated ability to listen skillfully, collect relevant information, determine immediate requests, and identify the current and future needs of the member
• A proficient problem-solving approach to quickly assess the current state and formulate recommendations
• Proficient in translating healthcare-related jargon and complex processes into simple, step-by-step instructions customers can understand and act upon
• Flexibility to customize the approach to meet all types of member communication styles and personalities
• Proficient conflict management skills, including the ability to resolve issues in a stressful situation and demonstrating personal resilience
• Ability to work regularly scheduled shifts within our hours of operation, including the training period where lunches and breaks are scheduled, with flexibility to adjust daily schedule and work overtime and/or weekends as needed
• All new hires will be required to successfully complete the Customer Service training classes and demonstrate proficiency of the material
• Ability to work within a team and collaborative environment
• Ability to multi-task, including understanding multiple products and multiple levels of benefits within each product
• Demonstrated ability in customer service problem resolution and relationship building
• Being able to address high-level concerns and satisfy them using scripting
• Familiarity with computer and Windows PC applications, including the ability to navigate and learn new and complex computer system applications
• Able to work overtime evenings, weekends, and holidays as needed based on the needs of the business

Benefits

• Competitive hourly pay plus PTO
• Health, Dental, Vision, and 403(b) with company match
• Ability to make important enhancements to the healthcare industry
• Great culture where you work with the founders and key stakeholders in a relaxed, but innovative atmosphere