Customer Service Representative II

How You Will Contribute Customer Support & Advocacy Maintains a positive and approachable demeanor in all customer interactions, showing a genuine interest in helping consumers and improving their experience.Helps member employees navigate their health insurance network providers.Independently provides customer service via telephone and email, answering questions and resolving issues related to electronic claims filing, repricing, network-related inquiries, and other established Customer Services processes.Refers consumers to the appropriate third-party administrator (TPA) or other resource for claims status, eligibility, or matters requiring assistance outside The Alliances scope.Provides education and resources to empower consumers to make informed health care decisions.Responds to written correspondence within established timeframes. Issue Resolution & Collaboration Researches customer questions and concerns using available systems and resources and identifies appropriate solutions or next steps.Independently resolves standard customer issues and determines when additional expertise, referral, or escalation is appropriate.Takes ownership of customer inquiries and supports timely follow-through and resolution.Accurately documents customer interactions, research, actions taken, and relevant information to support continuity of service.Collaborates with Customer Services staff, other departments, and appropriate external partners to resolve customer issues. Customer Insights & Continuous Improvement Proactively collects and shares consumer feedback to identify recurring concerns and opportunities to improve the customer experience.Recognizes patterns in customer inquiries and communicates observations to the Director or other appropriate Alliance staff.Contributes ideas and feedback that support improvements to Customer Services processes, resources, and service delivery.Maintains proficient knowledge of The Alliances networks, services, systems, terminology, and Customer Services processes.Assists with data entry and other departmental responsibilities as needed.