Customer Service Representative

Customer Service RepresentativeTo provide high-level customer service to PDTs' clients with accuracy.Principal Duties and Responsibilities - Goals on Performance ReviewAnswer calls from members, providers, and health plans regarding specific claim issues. Route and redirect calls as necessary.Return calls from the UM voicemail box within 24 hours.Perform timely follow-up on calls requiring research and call back within 24 hours.Accurately interpret DOFRs – Division of Financial Responsibility documents to determine where specific health care services are rendered.Verify eligibility & benefits for each submitted physician referral by contacting health plans for pertinent information.Work with contracting personnel to ensure the utilization of appropriate providers.Provide requested referral and network information to providers/staff promptly within 24 hours.Use MedMC to log incoming calls and their resolution.Complete other projects as assigned by the supervisorJob Specifications (KSAs):Requires the ability to speak, read, write, and understand English and other general educational skills, as is generally obtained by completing high school or a GED.Knowledge of the health or managed care industry is generally obtained through 1-2 years of work experience.Excellent communication skills with a focus on superior telephone etiquette.1-2 years of customer service experience required.IV Position Performance CriteriaAbility to organize and maintain multiple sets of information and data.Consistently produces accurate and timely work as it relates to departmental goals.Demonstrates high reliability through consistent punctuality and attendance.Competently performs position requirements with minimal supervision and direction, including taking initiative and assuming responsibility for follow-through.Uses sound judgment regarding time management and prioritization of work to balance multiple tasks and meet required timeframes for all administrative activities as required.Demonstrates excellent interpersonal skills as discerned through observation and team project successes.Accurately interprets and applies departmental policies and procedures using sound judgment.Communicates professionally and respectfully with peers, superiors, subordinates, and clients.Provides constructive feedback on assigned work projects.Demonstrates overall professionalism in attitude, demeanor, and personal appearance.