Customer Service Representative

Job Description - Customer Service Representative 

Provide excellent customer service primarily by telephone to all customers. Assist customers with coverage/claims related questions. Accurately interpret benefits and policy provisions for all products. Conduct appropriate research and follow-up for prompt resolution of disputed claims.

**Temp to hire opportunity!**

Essential Responsibilities:

• Work efficiently in a high volume call center while maintaining a professional, positive, and caring demeanor.
• Assist callers with coverage related questions/concerns; accurately interpret policy provisions for assigned products.
• Analyze customer’s inquiries and determine correct steps for resolution, interpret benefit information, and claims processing accuracy. Keep resource information up to date and well organized.
• Work efficiently in multiple systems simultaneously while effectively utilizing critical thinking and problem solving skills.
• Document calls in a clear and consistent manner in computer system.
• Conduct appropriate research, take ownership and follow through for prompt resolution of disputed claims.
• Relay information to appropriate departments and personnel using established communication channels and procedures.
• Make outbound calls to members as necessary dependent upon current outreach campaign.

Supporting Responsibilities:

• Meet department and company performance and attendance expectations.
• Be aligned with company values.
• Follow the privacy policy and HIPAA laws and regulations concerning confidentiality and security of protected health information.
• Perform other duties as assigned.

SUCCESS PROFILE

Work Experience: One-year medical insurance, other healthcare related field, call center or customer service experience required. CPT/ICD-10 coding preferred.

Education, Certificates, Licenses: High School Diploma or equivalent required.

Knowledge: Basic understanding of insurance and medical terminology, coding and standard medical billing practices preferred. Proficient computer skills, typing, and 10-key required. Strong written and verbal communication skills.