Customer Service Representative - Part time

JOB OVERVIEW

The Customer Service Representative will be responsible for all forms of member or participant level contact from members, providers, and occasionally employer and brokers.  The primary contact will be inbound calls.  Other forms of contact may include mail, email, fax, chat, and outbound calls.  Primary call types include benefits and eligibility, enrollment, claims, and retirement account questions. 

HOW WILL YOU DEMONSTRATE OUR VALUES AND POSITIVELY IMPACT OUR BUSINESS?  

DELIVER SERVICE

• Actively listen to caller questions and needs to provide quality answers to their understanding 

• Respond well in stressful, dynamic calls to promote a resolution to an issue

• Answer inquiries and promote the organization's products and services 

• Research and investigate complaints to ensure compliance and procedural adherence

• Develop, nurture, and sustain professional relationships with internal and external business partners by communicating well

• Observe protocol and utilize systems to deliver service consistent with department goals and provides an experience consistent with other team members

ESPRIT DE CORPS

• Take pride in our work as we deliver service customized to our member’s needs

• Contribute to the feedback process, technically, analytically, and creatively by sharing member and provider feedback with management so the process can be constantly refined to better service our members

• Generate and utilize system reports to review, analyze and optimize your key performance metrics for the best possible service

• Participate/support new business growth and retention as an agent providing a quality service experience – Enrollment was fast, it was easy and they were nice

BRING GUSTO

• Participate in team functions with a customer-centered focus 

• Provide feedback to leadership to pass along to internal teams regularly to assess and keep abreast of any escalating service issues

• Execute effective and timely resolutions demonstrating an ability to manage all facets of the problem/situation while advocating for the interest of the member/client while adhering to regulations and procedures

BE EXPERTS

• Know our accounts, products, scripts, and process so well that as a Customer Service Representative, you can anticipate needs, provide direction and execute resolutions on the first call

• Listen for the needs of the member, translate into actionable steps and communicate those steps to create understanding and correct expectations

OWN IT

• We can’t control the regulations and the policy language, but we own our tone and attitude

• Meet deadlines and be in attendance when expected

• Practice good office etiquette

SPECIFIC KNOWLEDGE, SKILLS, AND ABILITIES

• Highly motivated self-starter with the ability to accomplish and manage multiple priorities independently and simultaneously

• Ability to work as a team player with a committed positive approach to working through adversity

• Critical thinking skills with the ability to use logic and reasoning to identify deficiencies or other concerns in a dynamic environment

• Uses task system to be accountable and deliver on commitments

• Spends up to 100% of the time on phones

• Answer questions and handle problem resolution on benefit, provider or claim issues

• Follow up with members and providers as necessary

• Process benefit coverage changes and sends out supporting documentation as necessary

• Proactively manages expectations and sets realistic expectations for the caller

• Reads required disclosures to enrollees

• Follows privacy and HIPAA guidelines as trained

• Work schedule as agreed to and assigned 

• Adhere to attendance guidelines including tardiness, breaks, and ready to work at beginning of the shift

• Maintain Call Quality standards as assigned - Answer the number of calls within standards for hours scheduled

• Navigates system with proficiency 

• Possesses the necessary computer skills to consistently log on, work, and perform required functions

• Uses a tone and educational style to promote the understanding and acceptance of positive and negative outcomes

• Relies on instructions and guidelines to perform the functions of the job

• Collects detailed information and documents per protocol

EDUCATION AND EXPERIENCE

• Requires a minimum of a high school diploma or its equivalent 

• Experience in healthcare / medical benefits or claim inquiries / Retirement / Insurance and Customer Service

• Proven communication and customer service skills 

• Ability to adapt communication style based on the caller's needs 

• Responds well in a stressful, dynamic environment 

ADDITIONAL DETAILS

• While performing the duties of this job, the employee is regularly required to see, talk, hear, and use a keyboard and mail.  The employee frequently is required to sit.  The employee is occasionally required to stand and walk.  The employee must occasionally lift and/or move up to 10 pounds.

• Provide a professional work-from-home environment with high-speed internet.

• Business Travel:  Possibly one to two times per year for company-wide meetings and training

• Job Type:  Full-time