Customer Service Representative I - LBS

Resolves customer inquiries via telephone, fax, off-phone work, and email concerning account benefits, claim payments, enrollment, and related topics in accordance with Operational Risk Audit (ORA), HIPAA, and other legislative requirements.

About the role

This position requires participation in training immediately upon hire to become proficient in one line of business and independently perform the duties outlined. Training in a second line of business must be initiated and completed within 12 months of proficiency in the first to support cross-functional department needs. The initial line of business will be determined by the area of greatest need at time of hire.

Responsibilities

Level I

• Researches, documents, interprets, and responds to inquiries from internal and external customers, business partners, and special groups concerning products, services, and policies in accordance with ORA, HIPAA, and other legislative requirements.
• Researches and responds to questions related to claims, onboarding, effectuation, retention, provider inquiries, and other complex issues.
• Identifies and follows through on issues impacting the Health Plan and customer experience.
• Provides professional, efficient, and timely service to enhance member and provider satisfaction and retention.
• Exercises tact, patience, and professionalism in all customer interactions.
• Utilizes appropriate resources to resolve inquiries accurately and efficiently, ensuring acceptable quality, First Call Resolution, and performance.
• Develops effective internal working relationships to improve communication and collaboration.
• Shares ideas and solutions to improve processes, procedures, and systems.
• Participates in meetings, training, and skill development to support career growth and individual development plans.
• Maintains high standards of integrity by supporting the company’s mission and values, adhering to the Corporate Code of Conduct, and upholding the Lifetime Way values and beliefs.
• Ensures member privacy in accordance with corporate privacy policies and procedures.
• Performs other functions as assigned by management.

Level II (in addition to Level I Accountabilities)

• Provides expertise, daily support, mentoring, coaching, and guidance to other advocates.
• Assists with job shadowing and new employee training for multiple lines of business.

Requirements

All Levels

• High School diploma or equivalent.
• Customer service experience preferred.
• Strong communication skills across multiple channels (voicemail, email, outbound calls, etc.).
• Adept at communicating effectively and diplomatically while working collaboratively.
• Strong organizational skills and ability to prioritize in a fast-paced environment while remaining professional under pressure.
• Ability to resolve customer concerns by actively listening, navigating computer screens, typing call documentation, and speaking simultaneously.
• Excellent computer skills, including proficiency in a Windows environment and multitasking across multiple programs and applications.
• Proven reasoning and problem-solving skills.
• Ability to work occasional overtime as required.

Level II (in addition to Level I Qualifications)

• Performance rating of “Performing” or above in Level I for a consecutive 12-month period.
• Consistently proficient in all ancillary products.
• Ability to support specialized groups with custom rules and regulations based on multiple lines of business.
• Proven ability to resolve complex and escalated issues with minimal direction.
• Advanced system and navigational skills.
• Demonstrated global thinking and initiative to recognize team opportunities.

Physical Requirements

• Ability to work while sitting and/or standing at a workstation, viewing a computer, and using a keyboard, mouse, and/or phone for three or more hours at a time.
• Ability to hear, understand, and speak clearly while using a phone, with or without a headset.
• Ability to arrive at work on time and as scheduled.
• Ability to meet minimum performance metrics.

Pay

Compensation range: $20.00 – $24.43 per hour. Actual salary will vary based on factors including budget, prior experience, knowledge, skill, education, and internal equity.

Benefits

• Group health and/or dental insurance.
• Retirement plan participation.
• Wellness program.
• Paid time away from work and paid holidays.

Schedule

Opportunities for remote work may be available on a case-by-case basis.