Customer Service - Customer Service Representative Provider Connections 105-1066

About the role

As the first point of contact for all membership-related questions, requests, and concerns, you will provide outstanding service to our customers. You will address queries about benefits, eligibility, primary care providers (PCPs), claims, and other concerns, handle complaints, troubleshoot problems, and provide resolutions in a professional and polite manner to ensure first-contact resolution and customer satisfaction.

The ideal candidate is customer-focused, detail-oriented, and results-driven, demonstrating characteristics such as politeness, accuracy, adaptability, and the ability to work well within a team.

Responsibilities

• 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, creating a positive experience for the member.
• Verify eligibility, benefits, deductible amounts, claim status, copays, coinsurance, and all other information related to a customer’s benefits or a provider’s contract.
• Use effective listening skills to understand customer needs and complaints, offering the best possible solution while ensuring the member feels supported and valued.
• Resolve escalated customer issues received from members, providers, employer groups, or brokers while remaining calm and professional.
• Provide interpretation services for all product lines via the contracted language line service as appropriate.
• Work flexible hours, including weekends and evenings, as department or training needs dictate.
• Demonstrate problem-resolution skills that balance company and customer needs.
• Adapt to organizational changes, including business processes, systems, and technology.
• Collaborate with a team of Customer Service Representatives, fostering a positive relationship built on teamwork, trust, reliability, and excellence.
• Strive to meet or exceed call center metrics while providing excellent customer service.
• Participate in training and other learning opportunities to expand knowledge of the company and position.
• Perform other duties as assigned.

Qualifications

• Exceptional telephone manner, customer service skills, active listening skills, and strong verbal and written communication skills.
• Ability to resolve conflict and diffuse tension.
• Strong time management 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 and ability to adapt to change.
• Successful completion of a Health Care Sanctions background check.
• Bilingual skills a plus.

Requirements

• High school diploma or equivalent required.
• 1 year of customer service experience with direct interactions with customers.
• Contact center or medical field experience preferred.