Associate Customer Service Rep

Associate Customer Service Rep

Requirements

• High School Diploma or equivalent
• 1 year of relevant experience in related field

Responsibilities

• Analyzes, evaluates, resolves and responds to service inquiries from members, providers, employer groups, colleagues, agents, Elite agents (customers), and others within departmental guidelines.
• Partnering with internal and external resources, promptly provides customers with information and education concerning benefit clarification, eligibility requirements, verification, authorization, billing and claim status.
• Promptly identifies and resolves or escalates customer concerns or complaints to achieve positive outcomes. Places outbound welcome calls to members to educate them on their benefits as needed. Assists walk-in members and agents if assigned by leadership.
• Adheres to established procedure and quality guidelines in support of Priority Health service promise, key drivers, performance indicators, as well as Corporate values and codes of excellence. Identifies potential trends or issues that impact health plan members and works with coworkers and leadership resources to suggest process improvements.
• Assists members with administrative issues, such as submitting enrollment record changes, providing letter explaining coverage or benefits, and obtaining and relaying certain member information to other departments as needed.
• Facilitates claims resolution through follow-up on member calls and correspondence received to appropriate departments.
• Effectively tracks and/or documents all service interactions with customers within appropriate systems according to guidelines.
• Develops and maintains behaviors of productivity, availability to customers, and adherence to work schedule.

Preferred Qualifications

• Associate’s Degree