Customer Service Rep I

Summary

Curative is looking for a Customer Service Representative who is passionate about helping the company as we work to reinvent healthcare options. Candidates will be able to utilize their previous experience in the medical field/Customer Care by increasing satisfaction and retention by providing health plan members and providers with accurate, consistent, timely and meaningful information. They will provide support to members and providers while building rapport and collaborative relationships with current and prospective members in accordance with compliance guidelines. This is a remote call center position.

Essential Duties And Responsibilities

Answering phone calls and emails, assisting and resolving Provider and Member related requests regarding but not limited to the following:

• Assisting providers with all aspects of member benefit information, eligibility, referrals/authorization and claim processing information with 100% accuracy.
• Directing calls and emails to the correct department and escalating as needed.
• Building and maintaining solid provider relationships by handling questions, concerns, resolving issues/complaints with speed and professionalism while maintaining confidentiality per HIPAA guidelines.
• Documenting provider and member complaints, determines appropriate course of action and follow-up to ensure the complaint is resolved.
• Provides provider/ member outreach calls for resolutions and follow ups.
• Processes voicemail returns.
• Documents all interactions and transactions with the caller in the appropriate areas.
• Interacts and builds a solid relationship with Member Support, Medical Management, Pharmacy, Eligibility as needed.
• Provides provider and member portal support.
• Work adhering to US regulatory and Quality System requirements (21 CFR 820, etc).
• This position assumes and performs other duties as assigned.

Qualifications

To perform this job successfully, an individual must be able to perform each essential duty satisfactorily. The requirements listed below are representative of the knowledge, skill, and/or ability required. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions:

• 6 month to 1-year related experience and/or training in a call center environment in healthcare, insurance plan areas including knowledge of basic claim processing.
• Excellent attendance is critical to success in this position.
• Internal candidates must have been in their current role for at least 6 months and have no performance or attendance actions in effect.
• Excellent computer and phone skills, attention to detail, process and policy adherence.
• Excellent verbal and written communication skills.
• Strong interpersonal skills.
• Active listening skills to accurately respond to inquiries and requests.
• Exceptional organizational skills, retention of policy and process a must.
• Intermediate skills minimum in google and Microsoft office suite of products a must.
• Bilingual in English and Spanish preferred but not required.

EDUCATION And/or EXPERIENCE

❑ High school diploma or general education degree (GED); or one to three months related experience and/or training; or equivalent combination of education and experience.

CERTIFICATES, LICENSES, REGISTRATIONS

• Administrative/Healthcare a plus but not required.

WORK SHIFTS AVAILABLE

Monday – Friday 8am – 5:00pm CST

WORK ENVIRONMENT

• Remote position.
• Must have a quiet place, secure, with no distractions to perform duties for work from home.
• Must have password protected, stable internet access - a stipend will be provided.
• Work location MUST be secure and private to maintain HIPAA compliance for work from home.
• Office equipment will be supplied including PC, monitor, keyboard, mouse, headset
• While performing the duties of this Job, the employee is regularly required to sit; use hands to handle or feel; talk; and hear.
• The employee is frequently required to reach with hands and arms.
• Specific vision abilities required by this job include close vision, distance vision, color vision, peripheral vision, depth perception and ability to adjust focus.
• For this position the percentage of expected Travel is:0% of the time.

TRAINING EXPECTATIONS

• You will attend a 3-week minimum remote training program.
• Attendance is mandatory for the full training program
• Training will be Monday through Friday 8:30am - 5pm CST
• You will be required to take daily competency exams and a retention exam on the Friday of both weeks of training. Passing grades are 90% or above.
• We also request, with the exception of emergencies, that you do not request any time off within the first 120 days of employment.