Call Center Representative

Call Center Representative
Remote Role
Duration: 6 months

Overview:

Job Summary:
This Call Center Representative is a front-line service position aiding county benefit system members and providers regarding programs, policies, and procedures. Responsibilities include answering incoming calls related to eligibility, benefits, claims and authorization of services from members or providers. Responsibilities also include the administration of intake documentation into the appropriate systems. Overall expectations are to provide outstanding service to internal and external customers and strive to resolve member and provider needs on the first call. Performance expectations are to meet or exceed operations production and quality standards.

Responsibilities:

• Available to work scheduled work hours based on operational needs.
• Accurately respond to inbound phone calls and processing provider and member inquiries.
• Under general supervision resolve customers’ service or billing complaints by demonstrating sound judgement.
• Contact customers to respond to complex inquiries or to notify them of claim investigation results and any planned adjustments.
• Under general supervision resolve customer administrative concerns as the first line of contact - this may include claim resolutions and other expressions of dissatisfaction.
• Refer unresolved customer grievances, appeals, and claim resolution to designated departments for further investigation.
• Keep records of customer interactions and transactions, recording details of inquiries, complaints, and comments, as well as actions taken.
• Actively listens and probes callers in a professional and timely manner to determine purpose of the calls.
• Under general supervision research and articulately communicate information regarding member eligibility, benefits, services, claim status, and authorization inquiries to callers while maintaining confidentiality.
• Assume full responsibility for self-development and career progression; proactively seek and participate in ongoing training sessions (formal and informal).
• Educate providers on how to submit claims and when/where to submit a treatment plan.
• Under general supervision perform necessary follow-up tasks to ensure member or provider needs are completely met.
• Support team members and participate in team activities to help build a high-performance team.
• Thoroughly documents customers' comments/information and forwards required information to the appropriate staff.
• Escalate calls to Call Center Lead when necessary.
• Read, understand, and adhere to all corporate policies including policies related to HIPAA and its Privacy and Security Rules.

The list of responsibilities is not intended to be all-inclusive and may be expanded to include other education- and experience-related duties that management may deem necessary from time to time.

Qualifications:

Required Qualifications

• High School Diploma or GED equivalent
• Previous experience with computer applications, such as Microsoft Word and PowerPoint
• Previous customer service-related experience

Preferred Qualifications

• Verbal and written communication skills, attention to detail, customer service skills
• Ability to work independently and manage one's time
• Ability to accurately document and record customer/client information