Customer Service - Customer Service Representative Commercial 105-1083

Job Summary

Key Responsibilities

Qualifications

CommunityCare is an Equal Opportunity Employer

The ideal Customer Service Representative will be customer focused, detail oriented and results driven. The most successful Customer Service Representatives demonstrate the following characteristics: polite, accurate, knowledgeable, able to work well within a team, learning agility, flexible and easily adapts to change.

Process a high volume of incoming inquiries

• Regarding multiple products from members, providers, billing companies, individuals with legal representation, employer groups, and other insurance companies.
• Strive to achieve first call resolution by communicating accurate information efficiently and timely thereby creating a positive experience for the member.
• Verifies eligibility, benefits, deductible amounts, claim status, copays, coinsurance and all other information related to a customer and their benefits or a provider and their contract.
• Use effective listening skills to understand the needs and complaints of the customer to offer them the best possible solution and ensuring the member feels supported and valued.
• Resolve escalated customer issues received from the member, provider, employer groups or brokers while remaining calm and professional.
• Provide interpretation services for all product lines via the contracted language line service as appropriate.

Flexible hours

• Including weekends and evenings, as department or training needs dictate and at the discretion of management may be required.

Effective problem resolution skills

• Demonstrates balance of company and customer needs.

Training and other learning opportunities

• To expand knowledge of company and position.

Take part in training and other learning opportunities

Exceptional telephone manner, customer service skills, active listening skills, verbal and written communication skills

Ability to resolve conflict and diffuse tension

Strong time management skills and decision-making skills

Ability to read, comprehend, and explain health insurance benefits in a clear, concise, and professional manner

Ability to work under stress with production and quality standards

Proficient in Microsoft Office applications

Highly organized and attentive to detail

Flexibility, ability to adapt to change

Successful completion of Health Care Sanctions background check

Bilingual skills a plus

Education/Experience

• A high school diploma or equivalent required.
• One year customer service experience with direct interactions with customers.
• Contact center or medical field experience preferred.