The Call Center Representative will provide expert service to providers, members and clients who have claims, eligibility and benefit related questions by promptly responding to their concerns in a timely manner. In addition, this position resolves payment/adjudication questions at the time the call is received; explaining calculation methodology, contract terms procedures, etc. for the designated call center.
Field member and provider inquiries by phone and email
Customer service focus with a keen understanding of the importance of average speed of answer, average handle times, abandonment rates, and first call resolution
Answer customer service lines promptly and professionally and maintain at least a 95% response time.
Collaborate with teammates to investigate and resolve complex calls
Provide feedback to improve the Company
Clearly communicates claims status, payment methodology, contract terms, procedures, etc. to providers, members and clients.
Informs and assists callers with the claim's appeals process, where appropriate.
Demonstrates excellent customer service by determine the reason for the call, acknowledging the callers concerns and resolve concerns and/or explain action to be taken within the expected time line for resolution.
Performs research on complex claim inquires and expertly re-examines claims in order to drive first call resolution
Presents a pleasant voice to all callers, regardless of the stressful nature of the situation.
All other duties as assigned.
Maintain a knowledge of plan designs, PPO, indemnity plans, and all other contracts and services provided by company.
Medical terminology and insurance related experience a plus.
Strong interpersonal skills to interact with customers, management and peers.
Very organized and detail-oriented.
High level of self-motivation, productivity and attention to detail; be well-organized; have excellent verbal and written communication skills
Excellent analytical, problem-solving, multi-tasking, verbal and written communication skills
Flexibility to work evening hours based upon business need
Excellent attendance required