Customer Service Representative

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We are transforming healthcare to be value-driven, creating a seamless, consumer-centric care experience that maximizes value for all.

We believe that all health consumers are entitled to high quality, coordinated healthcare. We uniquely align the interests of health consumers, providers, and payors to make high-quality healthcare accessible and affordable to all populations across the ACA Marketplace, Medicare, and Medicaid.

JOB SUMMARY 

The Membership Enrollment - Customer Service Representative I provides support to providers and members by answering calls regarding eligibility, benefits, claims, and service authorizations. 

DUTIES & RESPONSIBILITIES 

The Membership Enrollment - Customer Service Representative job description is intended to point out major responsibilities within the role, but it is not limited to these items. 

• Answering incoming calls from providers and members 

• Provides eligibility, claims and authorization status. 

• Retrieves voice mails and responds. 

• Collaborates with internal and external partners to resolve issues from providers or members as they relate to claims payment, authorization and eligibility inquiries. 

• Creates, tracks and completes Customer Service Incidents to internal departments to resolve caller issues. 

• Participate in the discovery and resolution of root cause for recurring issues. 

• Ensure that all customer needs and problems are properly communicated and managed in a way that maintains great customer relationships. 

• Use customer service best practices to ensure a positive customer experience. 

• Meets daily, weekly, monthly metrics as written. 

• Other duties and responsibilities as assigned.  

EDUCATION AND PROFESSIONAL EXPERIENCE 

(LICENSURES AND CERTIFICATIONS) 

• High School diploma or GED required. 

• One (1) to three (3) years in the Health Insurance Industry preferred. 

• One (1) to three (3) years of customer service experience required. 

• Claims payor experience preferred, but not required. 

PROFESSIONAL COMPETENCIES 

• Strong communication skills, both verbal and written 

• Organized and able to prioritize work to meet deadlines 

• Able to work independently with little supervision 

• Able to thrive in an often-chaotic environment 

• Able to understand regulatory and compliance rules 

• Results and detail oriented  

• To be positive and accountable 

• Team unity 

WORK ENVIRONMENT 

The majority of work responsibilities are performed in an open office setting, carrying out detailed work sitting at a desk/table and working on the computer. <