Customer Service Representative I - Enrollment, Geisinger Health Plan (Eastern Standard Time Zone resident)

About the Role

Assists in resolving customer concerns, providing appropriate education and instruction, and maintaining customer satisfaction by delivering the highest level of customer service for enrollment. Actively participates in cross-training and process improvement within the Customer Service team.

Responsibilities

• Resolves and reconciles enrollment reports and related eligibility issues by following policy, procedure, and state legislated coverage and eligibility guidelines.
• Initiates communication and literature to newly enrolled Health Plan members, dependents, and employer groups.
• Interprets and applies rules and regulations in contractual agreements with employer groups and vendors.
• Performs membership data extract reports and supplies them to employer groups as an audit tool for accuracy and compliance with performance risk guarantee commitments.
• Updates, approves, and interprets membership data and workflow produced by online software capabilities in employer group modules.
• Determines eligibility of members, processes terminations, and disenrollments.
• Prepares, generates, and disseminates letter communications to subscribers and members regarding enrollment activity.
• Determines if services received are covered benefits as applicable by line of business and product design.
• Reviews suspended claims for resolution by applying current policies, procedures, and benefits applicable to specific products.
• Provides team-building resources to assist peers in directing proper claims resolution policies and procedures.
• Offers daily support and advice to member and provider services staff regarding claims issues.
• Researches claim issues from participating providers and identifies specific criteria for reconsideration for payment.

Work is typically performed in an office environment. Accountable for satisfying all job-specific obligations and complying with all organization policies and procedures.

Work At Home Requirements

• Quiet, Dedicated Workspace: A private, distraction-free area within your home to support focused work.
• Adequate Workstation Setup: Sufficient space to accommodate all employer-supplied equipment, including monitors, keyboard, and other peripherals.
• High-Speed Internet Connection:
  • Connection Type: Cable modem only (DSL, wireless cellular, and satellite services are not permitted).
  • Minimum Speed Requirements:
    • Download: 75 Mbps
    • Upload: 25 Mbps
    • Ping: Less than 150 ms
    • Jitter: Less than 30 ms
  • Connectivity: The computer must be connected via Ethernet cable. Wi-Fi is not permitted unless a Virtual Private Network (VPN) is used to secure the connection.

Requirements

• High School Diploma or Equivalent (GED) (Required).
• Minimum of 1 year of customer service experience (Required).

Benefits

• Healthcare benefits for full-time and part-time positions from day one, including vision, dental, and domestic partner coverage.
• Atmosphere of collaboration, cooperation, and collegiality from senior management down.

We are proud to be an affirmative action, equal opportunity employer. All qualified applicants will receive consideration for employment regardless of race, color, religion, sex, sexual orientation, gender identity, national origin, disability, or status as a protected veteran.