Customer Service Representative

Customer Service Representative

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