Customer Service Representative

Company Summary:  

S&S Health is a Third-Party Administrator specializing in a full-service health care delivery system.  

Position Summary:  

The Call Center Representative provides expert service to providers, members and clients who have claims, eligibility and benefit related questions by promptly responding to their concerns in a timely manner. In addition, this position resolves payment/adjudication questions at the time the call is received; explaining calculation methodology,
contract terms procedures, etc. for the designated call center within S&S Health. Some shift flexibility and mid-shift opportunities are available!  

Essential Functions:  

· Help providers and members navigate the complex healthcare ecosystem  

· Field member and provider inquiries by phone and email  

· Customer service focus with a keen understanding of the importance of average speed of answer, average handle times, abandonment rates, and first call resolution  

· Answer customer service lines promptly and professionally and maintain at least a 95% response time.  

· Collaborate with teammates to investigate and resolve complex calls  

· Provide feedback to improve the Company  

· Clearly communicates claims status, payment methodology, contract terms, procedures, etc. to providers, members and clients.
 

· Informs and assists callers with the claim’s appeals process, where appropriate.  

· Demonstrates excellent customer service by determine the reason for the call, acknowledging the callers concerns and resolve concerns and/or explain action to be taken within the expected time line for resolution.  

· Performs research on complex claim inquires and expertly re-examines claims in order to drive first call resolution  

· Presents a pleasant voice to all callers, regardless of the stressful nature of the situation.  

· All other duties as assigned.  

Minimum Qualifications:  

· Call Center experience necessary; healthcare call center experience preferred.  

· Demonstrated knowledge of health claims, coding and processing guidelines.  

· Maintain a knowledge of plan designs, PPO, indemnity plans, and all other contracts and services provided by S&S Health.  

· Medical terminology and insurance related experience a plus.  

· Strong interpersonal skills to interact with customers, management and peers.  

· Very organized and detail-oriented.  

· High level of self-motivation, productivity and attention to detail; be well-organized; have excellent verbal and written
communication skills  

· Excellent analytical, problem-solving, multi-tasking, verbal and written communication skills  

· Flexibility to work evening hours based upon business need  

· Excellent attendance required