Position Summary:
- Respond to and resolve various customer inquiries via telephone and correspondence, and resolve claims problems within established production and quality standards.
- Answer incoming calls and written requests for information from members or providers promptly and accurately.
- Compose routine and non-routine correspondence to answer member inquiries that require a written response.
- Coordinate with other departments to ensure timely and appropriate responses.
- Expedite and resolve complex issues and make claim adjustments.
- Educate others on the client product, providing accurate information and updates to policies and procedures, improving overall customer satisfaction in the process.
- In the Lead role, you will deal with the most complex cases and issues as an individual contributor or may focus on mentoring and acting as a backup for supervisory responsibilities.
- May assist in scheduling and coordinating team activities.
- Typically provide input in hiring decisions and performance appraisals.
- Handle the highest level of escalated and unresolved calls.
Your responsibilities will include but are not limited to:
- Successfully complete tier 2 training which covers some of the following:
- Handles escalated calls; may de-escalate calls
- Responds to member benefits in writing
- Peer to peer coaching /training
- Perform inventory reduction, routine to mid-level, (i.e. member inquiries, may adjust claims, responds to emails, etc.).
- May expedite, research, and resolve complex issues.
- Consistently perform established performance metrics, such as quality, production; average handling time (AHT) and calls per hour (CPH).
- Work with minimal supervision.
Requirements:
- Successfully meets requirements of nesting audit.
- Have strong customer service experience (especially phones) and a proven ability to meet performance standards.
- Strong organizational skills.
- Ability to work independently and to mentor others
- Ability to interpret the various health plans and any documentation associated with them.
$15.50/Hr
