Customer Service Representative
The Customer Service Representative is responsible for promoting favorable interaction with patients, providers and payers through prompt, accurate and courteous resolution of telephone and written inquiries. This position is primary responsible for inbound calls relating to medical, pharmacy, vision and related healthcare options.
- Assist members with questions, complaints and concerns as well as explain policies and procedures.
- Receive inbound calls from patients, providers, and members; occasionally return calls.
- Apply a variety of concepts, best practices and follow policy and procedures.
- Provide responses to inquiries and complaints for all phases of operations including billing claims, denials, payments, and others.
- Explain account situations to ensure member understanding.
- Respond promptly to written inquiries or provide call backs from messages.
- Aim to resolve inquires on the first call by being proactive and demonstrating product knowledge.
- Meet metrics for internal standards.
- Escalate advanced issues as appropriate.
- Candidates need to have prior experience with Medical Claims (need to be able to explain declination codes to customers, and needs to understand how to communicate what an explanation of benefits means to a customer).
- HS Diploma or equivalent.
- 1 year of customer service experience in a medical/healthcare setting including knowledge of medical terminology and working in a production environment.