We recruit, employ, train, compensate, and promote without regard to race, religion, creed, color, national origin, age, gender, sexual orientation, marital status, disability, veteran status, or any other basis protected by applicable federal, state or local law.
Under the direct supervision of the Customer Support Center Manager, the Customer Support Representative I (CSR) is the front line support to members, member advocates and providers. The CSR I provides superior customer service to all incoming callers while assisting with their inquiries and requests. Calls include but are not limited to eligibility verification, authorizations status, PCP changes, appeals and grievances. CSRs are expected resolve and/or escalate inquiries/requests and document each call interaction in a clear, concise, professional and timely manner.
Provide superior customer service to all incoming callers to ensure an exceptional customer experience.
Receive and respond to incoming calls from members, member advocates, providers, health plan representatives, etc. Identify and resolve issues related to patient care and services.
Provide assistance with inquiries such as eligibility, authorizations status, PCP changes, appeals and grievance intake, and various other inquiries.
Assist callers in connecting with other internal departments or external parties such as partner PCP offices, health plans, pharmacies, etc.
Educate callers on the use of the member and provider web portal.
Properly identify member’s health plan assignment for appropriate re-directing when necessary.
Collect, verify and update member demographic information in systems.
Make outbound calls for follow up purposes when needed. Set reasonable follow up expectations with callers and meet or exceed those commitments.
Continuously work on open inquiry log and maintain minimal open cases.
Use appropriate subject codes, accurately, thoroughly and clearly document all inquiries in tracking systems.
Recognize and alert management of inappropriate trends during customer calls. Provide process improvement recommendations.
Adhere to individual and departmental key performance indicators (KPIs) such as number of inbound calls per day, wrap up time, handle time, QA audit performance, abandonment rate, and service level.
Assist with training of new and existing staff when called upon.
Actively participate in all departmental meetings, training sessions, and other activities.
Maintain confidentiality of all protected health information in accordance with corporate guidelines.
Perform other duties as assigned.
High School Diploma or GED required. Associates or bachelor’s degree preferred.
Minimum of 2 years of ACD (Automatic Call Distributor) call center experience required.
Minimum of 1 year in medical or healthcare environment preferred.