Enrollment Specialist

Customer Service Representative

Primary responsibility is to ensure positive customer interactions with one major product line of the company's members. Interact with members, applicants, providers, and agents via telephone. Identify customer concerns and appropriately research and resolve inquiries in a timely manner. Continually trained and coached to enhance customer service skills.

Provide accurate and timely answers to benefit, coverage, premium, and claims questions to ensure member satisfaction. Assist with coordinating out-of-area or non-affiliated provider referrals for members requiring care outside of the service area. Answer Center for Medicare and Medicaid Services (CMS) test calls to ensure compliance with CMS guidelines. Assist Federally Facilitated Marketplace (FFM) members in updating financial and subsidy information to ensure compliance with federal guidelines. Document interactions with members electronically to maintain accurate member records. Utilize electronic systems to verify and assist with wellness benefits inquiries. Troubleshoot online portal and secure email issues for members. Assist members in filing complaints or grievances using internal and/or federal guidelines. Participate in continual coaching to maintain call volume, processing metrics, and accuracy goals. Regular attendance required to carry out essential functions. Review and meet ongoing competency requirements of the role.

May assist current Medicare Advantage members with plan changes using documented scripts provided by CMS. Other duties as assigned.

Two years' experience in customer service. Demonstrated proficiency with handling high-pressure situations and with verbal and written communication. Associate or Bachelor's Degree in business administration. Experience working in a health insurance call center.