Customer Service Representative

About the role

The Customer Service Representative is responsible for answering phone calls in a prompt and courteous manner to achieve contractual obligations. They answer members' and providers' questions with quick and accurate responses and ensure timely completion of all correspondence and reporting functions associated with the Customer Service Department.

Responsibilities

• Takes an average of 40‑60 incoming calls daily.
• Keeps pended work at a tolerable range (when applicable).
• Manages correspondence, faxes, and e‑mails in a timely manner.
• Maintains a monthly monitoring score of 90% accuracy or above on the 17 Points of Excellence.
• Demonstrates a complete understanding of departmental policies and procedures.
• Performs assigned tasks with minimal supervision.
• Meets requirements on the annual performance evaluation.
• Shows increasing improvement in performance and job knowledge.
• Documents calls according to departmental guidelines.

Requirements

• High school graduate or equivalent.
• Strong ability to relate to all customers.
• Excellent communication skills.
• Some knowledge of health care and insurance.
• Computer and keyboard skills.
• Proper usage of the English language.
• Consistently displays a positive attitude.

Preferred qualifications

• 1‑2 years of post‑high‑school education with a focus on healthcare.
• Previous call‑center experience.
• Knowledge of medical terminology.
• Knowledge of CPT and ICD‑10 coding.
• Familiarity with medical and hospital claims.

Schedule

8:00 am – 5:00 pm