Customer Service Representative

About the role

As a Customer Service Representative, you will play a pivotal role in ensuring the satisfaction of our customers by responding to their inquiries, resolving issues, and providing information through inbound telephone communication. Your primary responsibility will be to manage incoming customer service calls professionally, ensuring that each customer's needs are addressed effectively and efficiently.

Responsibilities

• Communicate and provide service to preferred providers in order to build positive supporting relationships.
• Assist members, providers, and healthcare providers with benefit inquiries, referral prior authorizations status, and eligibility via inbound telephone calls.
• Research and identify processing inaccuracies in claim payments and route to the appropriate team for claim adjustments.
• Maintain and submit thorough and organized records of all interactions, inquiries, and resolutions in the customer service email alias.
• Follow up on customer issues, research problems, and process documents necessary to ensure a successful resolution.
• Stay updated on company policies, procedures, and compliance regulations in the healthcare and insurance industry.
• Provide clear, articulate communication to accurately describe our services to members/providers and collect information.
• Handle calls and correspondence that are predominantly routine but may require some deviation from standard procedures.
• Collaborate with other customer service representatives and departments to address complex member issues and improve overall client and member experience.
• Perform any other duties that may be requested by supervisor or management.

Requirements

• High School Diploma or equivalent required.
• 1–2 years’ experience in the insurance industry required.
• Good verbal and written communication skills.
• Inherent service orientation; ability to remain calm and communicate tactfully both externally and internally.
• Strong knowledge of commonly used concepts, practices, and procedures in the insurance field.

Work Environment

The noise level in the work environment is usually low to moderate.

Physical Demands

• Regularly required to talk or hear.
• Frequent use of hands or fingers; handling or feeling objects, tools, or controls.
• Occasional standing, walking, sitting, and reaching with hands and arms.
• Occasionally required to lift and/or move up to 25 pounds.
• Vision requirements include close vision, distance vision, and the ability to adjust focus.

Travel Requirements

None