Customer Service Representative I (2796)

Purpose Of Position

The Customer Service Representative I handles calls from customers to resolve, educate, follow-up and respond to questions regarding California Choice/Choice Builder plan administration and procedures groups, members, brokers and general agencies.

Essential Functions

• Understands company policies and procedures as they apply to California Choice/Choice Builder plans.
• Answers questions by telephone from groups regarding new hires, billings, rates, supplies, administrative procedures, etc.
• Educates, via telephone, employees/dependents regarding PCP’s, ID cards, RX problems, administrative procedures, dependent coverage, address changes, etc.
• Follows-up on calls and emails from brokers regarding problems that their groups are experiencing with providers.
• Interacts with brokers, general agents and sales representatives on a daily basis and answers questions regarding California Choice processes.
• Responds to calls from providers to confirm eligibility and benefits.
• Verifies enrollments and resolves issues with carriers.
• Expedites processing of members' enrollment with carrier if urgent services are needed.
• Reviews and submits appeal requests from groups.
• Reviews and audits group billing and explains to clients in clear and accurate manner.
• Documents calls in call tracking system.

Qualifications

• At least two (2) years of customer service experience preferred.
• Knowledge of the health insurance industry and customer service experience preferred.
• Ability to handle irate customers in a courteous, patient, calm and positive manner while maintaining a high quality and quantity of work.
• Experience in handling high call volume.
• CA Life & Health license required. If successful applicant does not have insurance license, it is required to obtain one within six (6) months of date of hire.
• Excellent verbal and written communication skills, especially under pressure.
• Computer literate in Microsoft Word, Excel and Outlook. Accurate data entry skills a must. Typing at 55 WPM or more.
• Able to work in a fast-paced environment where deadlines are a priority and handling multiple assignments simultaneously.
• Problem Solving Skills required.
• Proficient knowledge of the English language. Proficient knowledge of the Spanish language is a plus.
• If hired as a Bilingual representative, Language Assistance Certification is required every two (2) years.

Additional Competencies

• Action Oriented
• Approachability
• Customer Focus
• Humor
• Listening
• Patience
• Self-Knowledge
• Technical Learning
• Time Management
• Written Communication

Physical Requirements

• Must be able to sit for extended periods of time and occasional standing and walking.
• Must have adequate hearing for phone work.
• Vision requirements include close vision and the ability to adjust focus.
• Must be able to communicate effectively in English.
• Must be able to use a keyboard and other office equipment.
• Able to lift up to 10 pounds occasionally.