Customer Service Representative

Job Summary and Responsibilities

The purpose of this position is to answer incoming telephone calls, and resolve customer questions, complaints, and requests while adhering to internal policies and procedures.

• Regular and reliable attendance is required, including the ability to work scheduled hours and meet job responsibilities in a timely manner.
• This position primarily involves working at a desk and using a computer for extended periods of time.

Responsibilities:

• Develop and maintain working knowledge of internal policies, procedures, and services.
• Utilize automated systems to log and retrieve information; perform accurate and timely data entry.
• Receive inquiries by telephone, email, fax, or mail and communicate responses within required turnaround times.
• Respond to telephone inquiries in a prompt, accurate, and courteous manner.
• Interact with external partners such as hospitals, physicians, beneficiaries, or other program recipients.
• Perform verification of healthcare services to facilitate payment for received services.
• Serve as liaison between the internal and external partners.
• Investigate and resolve or report provider problems.
• Meet or exceed standards for call volume and service level per department guidelines.
• Initiate cases by collecting and entering demographic, provider, and procedure information into the system.
• Complete daily, monthly, and quarterly reports necessary for clinical team operations.
• Read, understand, and adhere to all corporate policies including policies related to HIPAA and its Privacy and Security Rules.

Qualifications

• Requires a High School diploma or equivalent.
• Requires a minimum of two years of customer service experience or related experience.
• Knowledge of medical terminology.
• Knowledge of the health insurance industry.
• Effective verbal and listening skills.
• Bilingual Spanish-English a plus.

Why Us?

We are a team of experienced and caring leaders, clinicians, pioneering technologists, and industry professionals who come together to redefine expectations for the healthcare industry. State and federal healthcare agencies, providers, and employers turn to us as their vital partner to ensure better healthcare and improve health outcomes. We do this through our people. You will have meaningful work that genuinely improves people's lives across the country. We are a company that cares about our employees, and we give you the tools and encouragement you need to achieve the finest work of your career.

Benefits

• Comprehensive health plans.
• Paid time off.
• Retail savings.
• Corporate wellness.
• Education assistance.
• Corporate discounts.

Experience in Lieu of Degree

For non-clinical roles, or when not required by the contract specifically, the Company acknowledges that practical, hands-on experience can provide skills and competencies equivalent to formal education. As such, in cases where a Bachelor's degree may be required, the Company will accept a minimum of six (6) years of directly relevant professional experience in lieu of a degree. In instances where the candidate has an Associate's degree, the Company will accept a minimum of three (3) years of directly relevant professional experience in lieu of the Bachelor's degree.

Pay Range

The pay range for this position is listed below. "Based on our compensation philosophy, an applicant’s position placement in the pay range will depend on various considerations, such as years of applicable experience and skill level."