Customer Service Specialist

The hourly rate for this position is between [$21 - $22 per hour]. Factors which may affect pay within this range may include geography/market, skills, education, experience, and other qualifications of the successful candidate.

Benefits:
The Company offers the following benefits for this position, subject to applicable eligibility requirements: [medical insurance], [dental insurance], [vision insurance], [401(k) retirement plan], [life insurance], [long-term disability insurance], [short-term disability insurance], [paid parking/public transportation], [paid time off], [paid sick and safe time], [hours of paid vacation time], [weeks of paid parental leave], paid holidays annually] as applicable

About the Role

• This position is a customer advocate role focused on supporting members and providers by facilitating care and service.
• The role involves providing assistance regarding various aspects of healthcare programs, policies, and procedures.
• The primary responsibility is to handle incoming and outgoing calls related to healthcare benefits, ensuring outstanding service and striving to resolve callers needs on the first call.

Responsibilities

• Research and communicate medical information regarding services such as claims, member eligibility, benefits, EAP services, claim status, and authorization inquiries while maintaining confidentiality and protecting health information.
  Meet key performance indicators and service standards, demonstrating compassion to members and providers.
• Identify and respond to crisis calls with appropriate resources.
• Facilitate routine referrals and triage decisions that do not require clinical judgment.
• Assemble and enter patient information into the appropriate delivery system.
• Demonstrate flexibility in job duties and schedule to better serve members and achieve business and operational goals.
• Support team members and participate in activities to build a high-performance team.
  Assume responsibility for self-development and career progression by participating in ongoing training sessions.
• Stay informed of operational changes to ensure accuracy.
• Identify and report operational problems and inefficiencies to responsible entities.
• Lead or participate in activities to improve Care Center performance, quality, and culture.
• Navigate systems to document customer comments and information, forwarding required information as necessary.
• Read and retain information from multiple resources to ensure calls are addressed accurately and appropriately.

Education Qualification

• High school diploma or equivalent required.
  Additional education or certifications in healthcare or customer service are a plus.

Required Skills

• Strong communication skills with the ability to articulate medical information clearly.
  Ability to maintain confidentiality and handle sensitive information.
• Compassionate and customer-focused approach.
  Flexibility in job duties and schedule.
  Ability to work collaboratively in a team environment.
• Proactive in self-development and career progression.
• Strong problem-solving skills and attention to detail.
• Proficient in navigating and using various systems and resources.

• claims
• member eligibility
• benefits
• EAP services