Customer Service Representative (POPA)

JOB TITLE:

Customer Service Representative I

DEPARTMENT:

Service Center

REPORTS TO:

Aimel Gomez-Guerrero

JOB DUTIES:

Customer Service Representative I

Provides exemplary services, by phone or in person to the customers of the Trusts ZAS administers. Interacts with customers and other departments to investigate, resolve and provide information in response to inquiries about claims, benefits, eligibility and complaints.

Responsibilities include:

• Quote and explain benefits regarding Plan Coverage (Medical, Dental, etc.)
• Assist customers with problems and questions regarding claims
• Handle escalated customer concerns and complaints
• Answer phones and handle walk-ins
• Document interactions with customers into ZAS's Encounter Tracking/Database System
• Move between phone and front desk support as required by daily departmental needs
• Identify potential problems/patterns/solutions and escalate for management review
• Ability to learn Trust processing guidelines, benefit structure, system procedures and miscellaneous guidelines
• Cross-trained on multiple ZAS accounts
• Must meet the department's quality and production standards for this job, as provided on the work standards grid.

JOB REQUIREMENTS:

Minimum Education & Experience

• HS or GED
• Minimum 1 year experience in Customer Service or related work experience
• Claims processing knowledge helpful
• Healthcare background preferred
• Bilingual preferred

Mental/Visual concentration or Manual Dexterity

• Requires normal concentration
• Easily learned, simple movements

Computer Operations

• Must be PC literate
• Basic knowledge of Microsoft Excel & Word
• Working knowledge of HCFA, CPT, ICD9, HCPCS and other medical coding protocols
• Data entry and 10-key proficient (35-40WPM)
• Proficient in ZAS operating systems

Physical Work Environment

• Normal degree of physical effort in typical office environment with comfortable, constant temperatures and absence of objectionable elements
• May be subject to interruptions
• May be required to lift a maximum of 25 lbs
• Must be able to have flexible work schedule when workflow requires
• Meet established attendance and punctuality guidelines.

Customer Focus

Understand customer needs, both internal and external.

COMPETENCIES:

Quality Focus

• Looks for opportunities to provide the highest quality service.
• Maintains appropriate documentation
• Works with other employees/departments to ensure timely and quality service.

Analysis

• Strong analytical/problem solving skills
• Strong research skills
• Mathematical proficiency required.

Planning

• Solid organizational skills
• Ability to prioritize and multi-task.

Communication

• Solid written and verbal skills
• Listens actively and communicates effectively with participants, co-workers, clients, employers and vendors.

Interpersonal Relations

• Assists participants, co-workers, clients, employers and vendors in a friendly, courteous, and professional manner.
• Uses courtesy in communication and working with others.
• Works with other employees/departments to ensure timely and quality service
• Patience and rapport with others required.

Teamwork

• Works well in a team environment with minimal supervision