The Customer Service Representative is responsible for providing exceptional customer service, possess excellent problem solving skills, with the ability to “think on your feet”. Must have excellent “people” skills be goal-oriented, flexible and enjoy assisting customers in a friendly and respectful manner. Ideal candidates are positive, energetic, enthusiastic and computer savvy.
Essential Duties and Responsibilities
The essential functions include, but are not limited to the following:
- Direct communications with members, providers and health plans.
- Confirmation of benefits and eligibility information to members, providers and health plans.
- Provide confirmation of participating providers in the network.
- Provide claim status to members, clients and providers
- Resolves problems by identifying the customer’s complaint; selecting and explaining the best resolution for the issue; escalates to upper management when necessary.
- Keep managers informed of any issues that may require their attention in order to avoid or resolve an existing problem.
- Apply knowledge, experience, common sense, and critical thinking to all issues being dealt with. Multi task and prioritize
- Respond to general inquiries from members and providers (plan benefits, limits, co-pays, deductibles, policy procedures, reimbursements, etc.). Redirect callers when necessary
- Follow up until completion on all issues that are not resolved on the initial contact, keep parties updated on steps and actions taken.
- Service the maximum amount of callers in the quickest and most efficient way without sacrificing the quality of the service.
Minimum Qualifications (Knowledge, Skills, and Abilities)
- 1+ years Customer Service experience in Healthcare or related experience
- High School Diploma or equivalent certification
- Excellent Communication Skills
- Must be computer literate and able to quickly navigate in a windows PC environment
- Typing skills 35 WPM
- Ability to talk on the phone, use a computer and keyboard simultaneously
- Must have a “can do” attitude
- Must be organized, assertive and patient
- Experience with Optometry, Ophthalmology and or Podiatry specialties.
- Bilingual (English and Spanish) preferred.
Physical Demands and Work Environment
The physical demands described here are representative of those that must be met by an employee to successfully perform the essential functions of this position. Reasonable accommodations may be made to enable individuals with disabilities to perform the functions.
- Frequent speaking, listening using a headset, sitting, use of hands/fingers across keyboard or mouse, handling other objects, long periods working at a computer
- Service center environment with moderate noise level due to Representatives talking, computers, printers, and floor activities