Customer Service Specialist

Customer Service RepresentativeResponsible for being the first point of contact for all membership related questions, requests and concerns and for providing outstanding service to our customers. You will answer queries regarding customer benefits, eligibility, PCPs, claims and other questions. You will handle complaints, troubleshoot problems and provide resolutions in a professional and polite manner to ensure first contact resolution and customer satisfaction. The ideal Customer Service Representative will be customer focused, detail oriented and results driven. The most successful Customer Service Representatives demonstrate the following characteristics: polite, accurate, knowledgeable, able to work well within a team, learning agility, flexible and easily adapts to change.Key Responsibilities:Process a high volume of incoming inquiries regarding multiple products from members, providers, billing companies, individuals with legal representation, employer groups, and other insurance companies.Strive to achieve first call resolution by communicating accurate information efficiently and timely thereby creating a positive experience for the member.Verifies eligibility, benefits, deductible amounts, claim status, copays, coinsurance and all other information related to a customer and their benefits or a provider and their contract.Use effective listening skills to understand the needs and complaints of the customer to offer them the best possible solution and ensuring the member feels supported and valued.Resolve escalated customer issues received from the member, provider, employer groups or brokers while remaining calm and professional.Provide interpretation services for all product lines via the contracted language line service as appropriate.Flexible hours, including weekends and evenings, as department or training needs dictate and at the discretion of management may be required.Qualifications:Exceptional telephone manner, customer service skills, active listening skills, verbal and written communication skills.Ability to resolve conflict and diffuse tensionStrong time management skills and decision- making skills.Ability to read, comprehend, and explain health insurance benefits in a clear, concise, and professional manner.Ability to work under stress with production and quality standards.Proficient in Microsoft Office applications.Highly organized and attentive to detail.Flexibility, ability to adapt to change.Successful completion of Health Care Sanctions background check.Bilingual skills a plus.Education/Experience:High school diploma or equivalent required1-year customer service experience with direct interactions with customersContact center or medical field experience preferredCommunityCare is an equal opportunity at will employer and does not discriminate against any employee or applicant for employment because of age, race, religion, color, disability, sex, sexual orientation or national origin CommunityCare