REMOTE: Customer Service Representative - CSR

Job Description

Job Description

Customer Service Representative Job Description

Job Summary:

We are searching for a patient and attentive Health Care Customer Service Representative to join our Call Center. You will be required to provide outstanding service to our customers. You will be required to answer queries, handle complaints, and troubleshoot problems in a professional and polite manner to ensure effective resolution and customer satisfaction.
You will be expected to resolve queries from customers and provide information regarding: pre-authorization for medical treatment, claim status, benefit information, provider information, etc.
To ensure success as a Health Care Customer Service Representative, you should be able to process and disseminate vast amounts of information. An outstanding Health Care Customer Service Representative will possess an aptitude for learning and continual development.
The ideal Customer Service Representative will be customer-focused, detail orientated, and target driven. You should be polite, accurate, knowledgeable, and able to work well within a team.



 
Responsibilities :

• Analyzes and answers requests by telephone from all customers including policyholders, beneficiaries and providers concerning insurance or self- funded policies.
• Uses systems for tracking, information gathering, or troubleshooting.
• Completes documentation and call tracking via computer system for all calls.
• Familiarizing yourself with and remaining up-to-date with changes in our plans.
• Greeting customers in a friendly, professional manner using the suggested script.
• Answering telephonic and e-mail inquiries in a timely manner.
• Deferring queries to your manager if you are unable to answer them.
• Furnishing members and health care practitioners with details regarding members' benefits.
• Advising if pre-authorizations for medical treatment is covered.
• Advising members of patient responsibility.
• Providing members with the details of provider network status.

Complexity of Work:

• Within scope of job, requires critical thinking skills, decisive judgment and the ability to work with minimal supervision. Must be able to work in a stressful environment.

 
Personal Protective Equipment:

• Follows Standard Precautions using personal protective equipment as required. 

 
Minimum Qualifications (Skills):

• Familiarity with Medical terminology, CPT codes, HCPCS, Diagnosis Codes required. ADA codes preferred.
• Prior experience as a Customer Service Specialist or equivalent required.
• Computer literate with an above-average typing speed.
• Good mathematical skills.
• Superb verbal and written communication skills.
• Thorough, with excellent listening skills.
• Ability to calm irate, anxious, or grieving customers.
• Capacity to navigate stressful situations with ease.
• Available to work shifts, which may include work during evenings, weekends, and public holidays.

 
Education:

• Associate Degree preferred. In lieu of an Associate Degree, 1-2 years of Health Insurance Customer Service experience in Call Center is acceptable.

 
Work Experience:

• Prior experience as a Customer Service Specialist or equivalent, ideally within a similar setting.
• Healthcare experience.

Populations Served:

• No Responsibility to treat or care for patients.