Job Description: Sr. Customer Service Advisor
*Sr. Customer Service Advisor must have thorough understanding of product base and demonstrate proficiency and consistently meet or exceed performance expectations in all of the requirements for Customer Service Advisor. A primary function of Sr. Customer Service Advisor is to demonstrate the ability to perform at least one service function at the highest level with a greater degree of proficiency, as well as the ability to demonstrate competence at their cross functional ability to perform in another area of service expertise to include claims processing of adjustments, claims adjudication, complex claims adjustments, processing of emails and written correspondence. At Sr. Customer Service Advisor, the scope of the position is focused on building skills in all remaining areas of service at a meets level or above. Additionally, the incumbent will focus on tangible contributions to the overall performance, development and success of the associate staff through effective team skills, quality improvement, productivity, business flexibility, and customer retention
* 25% Use knowledge of products and the contractual provisions that govern administration to provide effective customer service and education, to interpret contractual language to client for the purpose of providing benefit utilization and limitations, to determine the need for managed care initiatives, and to administer all types of service to a client within the business segment through telephonic inquiries, written and/or electronic inquiries and claims adjustments. Appropriate documentation of all client interactions according to established departmental procedures.
* 25% Demonstrates the ability to perform at least one service function at the highest level with a greater degree of proficiency, as well as the ability to demonstrate competence at their cross functional ability to perform in another area of service expertise, such as claims adjudication, complex claims adjustments, processing of emails and written correspondence.
* 20% Provides effective training, coaching, and motivation for Level I associates. Demonstrated ability to be a resource for new and existing associate staff. Demonstrates best practices and learned skills in order to assist the team and department with improved quality, productivity and performance metrics.
* 15% Uses FLEXX and/or CARE and/or NASCO systems, product, contract and medical policy knowledge and processing techniques to resolve client inquiries. Demonstrates the flexibility to process and service various types of products within each line of business according to the established quality, productivity and performance metrics.
* 15% Learns information required to effectively administer service to clients as it relates to inquiries concerning pre-existing condition, knowledge of policies and riders, identification of other insurance and coordination of benefits, benefit exclusions, administration of direct pay, credit card payment, debit accounting and other enrollment and billing transactions.
* Works more independently but work is audited for quality assurance. Achieves meets level or above in customer satisfaction measures, divisional and corporate performance metrics established by MTM, ITS, NCQA, accounting audits, performance guarantees, performance contracts and service level agreements. All Service personnel may be required to dedicate up to 100% of their productive time on phone coverage as deemed necessary by the department
* Required: High School diploma or equivalent. Position requires 2-5 years prior customer service and/or claims adjudication experience. The incumbent must be cross trained between service and claims adjustment with the ability to handle more complex issues
* Abilities and Skills: Use of automated systems, PC or CRT proficiency, excellent oral and written communication skills, time management and organizational management skills. Strong analytical abilities and problem-solving skills. Ability to work independently and as part of a team in a fast paced work environment for the development of associate staff and the department through effective team skills, quality improvement, productivity, business flexibility and customer retention
* Preferred: 2-4 years of college in Business or other related education. Healthcare and/or Insurance industry experience is a must. Bilingual in Spanish/English is a bonus
* The incumbent is required to immediately disclose any debarment, exclusion, or other event that makes him/her ineligible to perform work directly or indirectly on Federal health care programs
* The physical demands described here are representative of those that must be met by an employee to perform the essential duties and responsibilities of the position successfully. Requirements may be modified to accommodate individuals with disabilities. The employee is primarily seated and handling inbound telephone inquires at a minimum of 95% of their work schedule. Occasional walking or standing is required. The hands are regularly used to write, type, key and handle or feel small controls and objects. The employee must frequently talk and hear. Weights of up to 25 pounds are occasionally lifted.