Customer Service Representative

The Customer Service Representative is responsible for answering phone calls in a prompt and courteous manner to achieve contractual obligations. Responsible for answering Member's and Provider's questions with a quick and accurate response. They are also responsible for timely completion of all correspondence and reporting functions associated with the Customer Service Department.


Required:

1. High School Graduate: prefer 1-2 years college with interest or concentration in health field.
2. Strong ability to relate with a variety of people in a non-judgmental manner.
3. Strong organizational, verbal and written communication skills.
4. Possess some knowledge of the health care system.
5. Personal Computer (PC) and Keyboard skills.
6. Proper usage of the English Language.
7. Courteous manner/even temperament.
8. Excellent communication skills.

Desired:

1. Previous call center experience.
2. Medical Terminology.
3. CPT and ICD-9/ICD-10 Coding.
4. Familiar with medical and hospital claims.
5. Familiar with Prescription Coding (NDC).
6. Familiar with Coordination of Benefits Ruling.

Responsibilities:

1. Takes an average of 40-60 calls daily.
2. Has established adequate proficiency in using the application necessary to perform the functions of a Customer Service Representative.
3. Maintains monthly monitoring score of 90% accuracy or above on the 17 Points of Excellence.
4. Demonstrates a complete understanding of departmental policies and procedures.
5. Able to perform assigned tasks with minimal supervision.
6. Meets requirements on annual performance evaluation.
7. Consistently displays a positive attitude and acceptable attendance.
8. Increasing improvement in performance and job knowledge.
9. Documents calls according to departmental guidelines.

Equal Opportunity Employer

The Health Plan is an equal opportunity employer and complies with all applicable federal, state, and local fair employment practices laws. The Health Plan strictly prohibits and does not tolerate discrimination against employees, applicants, or any other covered persons because of race, color, religion, creed, national origin or ancestry, ethnicity, sex (including gender, pregnancy, sexual orientation, and gender identity), age, physical or mental disability, citizenship, past, current, or prospective service in the uniformed services, genetic information, or any other characteristic protected under applicable federal, state, or local law. The Health Plan employees, other workers, and representatives are prohibited from engaging in unlawful discrimination. This policy applies to all terms and conditions of employment, including, but not limited to, hiring, training, promotion, discipline, compensation, benefits, and termination of employment.

8:00am - 5:00pm
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