Customer Service Representative

Essential Duties and Responsibilities

• Answer incoming customer inquiries received via telephone, Interactive Voice Response (IVR), web chat functions, or other approved contact channels in accordance with performance standards, policies, procedures, and confidentiality and privacy requirements.
• Provide accurate information regarding programs and services to consumers, prospective enrollees, individuals acting on behalf of enrollees, health plans, and providers.
• Track, document, and record all customer interactions, inquiries, complaints, comments, actions taken, and transactions in applicable systems.
• Complete associated tasks and transactions according to established guidelines to ensure accuracy and completeness.
• Navigate multiple computer systems while interacting with customers and perform data entry accurately.
• Facilitate fulfillment of customer requests for materials via mail, email, or electronic delivery as appropriate.
• Transfer or refer customers to appropriate internal or external entities in accordance with established guidelines.
• Address customer inquiries and resolve routine issues to ensure appropriate actions or updates are completed.
• Escalate unresolved, complex, or sensitive issues or grievances to designated staff or departments for further investigation or resolution as needed.
• Facilitate translation or interpretation services for non-English speaking customers according to procedures.
• Communicate with supervisors regarding potential needs, concerns, or issues impacting service delivery.
• Meet Quality Assurance (QA), productivity, and other key performance metrics.
• Attend required meetings and trainings and maintain up to date knowledge of all programs, systems, policies, and procedures.
• Perform other related duties as assigned by management.

Minimum Requirements

• A high school diploma or GED required and 0-6 months of relevant professional experience required, or equivalent combination of education and experience.

Job Requirements

• Able to demonstrate logical problem-solving skills, capacity to multi-task, and proficiency to utilize the client approach to troubleshoot.
• Proficient in managing repetitive and high-volume calls.
• Proficient typing skills.
• Consistently showcases a strong sense of urgency and performs well under pressure.
• Strong organizational and work prioritization abilities.
• Skilled in the use of Teams.
• Fundamental computer proficiency in Windows and/or Mac.
• Available to work any 8-hour shift Monday to Friday from 8:00 a.m. to 6:30 p.m. (Central Time).

Training Requirements

• Must be able to work onsite first week of training.
• Must be able to complete classroom and on-the-job training with no time missed.

Required Guidelines for Remote Work Environment

• Workspace must be quiet, free of distractions, and no background noise.
• Workspace must be able to hold 2 monitors, laptop, keyboard, mouse, and docking station: Maximus will provide equipment.
• Web camera is required for all Maximus and agency staff during training, meetings, or as requested by management with expectation of participation, adequate lighting and visibility.
• Internet must be a traditional, wired high-speed connection such as cable or fiber.
• Must be able disable modem firewalls to ensure proper VPN and product access.
• High-speed internet service is required, with minimum of 20 Mbps download & 5 Mbps upload.
• Work-from-home staff may be required to work on-site for those who fail to meet the work-from-home guidelines and/or whose performance is not at an acceptable level.
• Must work and reside within Texas.
• Live within 70 miles of site: Edinburg, Tx.