Customer Service Representative

About the Role<br />The Customer Service Representative assists members, physicians, hospitals, revenue agencies and other healthcare providers with member benefits, eligibility, claims inquiry, claim reconsiderations, and appeals. The Customer Service Representative must be able to work in various shifts Monday to Friday between the hours of 9 AM – 7 PM EST with the ability to adjust shifts with notice based on business needs.<br /><br />This job description is not designed to cover or contain a comprehensive listing of activities, duties or responsibilities and activities may change, or new ones may be assigned at any time with or without notice.<br /><br />Primary Responsibilities<br /><br />Handle inbound calls from members, medical providers, and others.<br /><br />Adjust claims accurately, if needed.<br /><br />Listen to and address customer needs and concerns empathetically.<br /><br />Answer questions about fee schedules, network participation, and requirements.<br /><br />Ensure first contact resolution when possible.<br /><br />Update customer files and communicate effectively with teams.<br /><br />Transfer misdirected requests and offer solutions to non-routine issues.<br /><br />Contribute to customer satisfaction and business improvement.<br /><br />Use decision-support tools to provide accurate responses.<br /><br />Investigate inquiries using training and systems.<br /><br />Adapt responses to caller understanding.<br /><br />Educate callers and validate their understanding.<br /><br />Support projects and other departments as directed by management.<br /><br />Essential Qualifications<br /><br />High school diploma with some college or business school education preferred.<br /><br />Basic computer operations knowledge.<br /><br />Intermediate proficiency in Microsoft Office (Word, Excel, Access, PowerPoint, Outlook).<br /><br />Strong time management skills.<br /><br />General knowledge of HIPAA Confidentiality laws.<br /><br />Quick learner with ability to grasp managed care procedures and claims payment policies.<br /><br />Detail-oriented and dependable.<br /><br />Effective listening and responding skills.<br /><br />Flexible and adaptable to changes, with conceptual thinking.<br /><br />Strong problem-solving abilities.<br /><br />Excellent attendance and punctuality.<br /><br />Comfortable performing tasks at a computer/telephone station.<br /><br />Effective communication through various channels, including email, chat, and voice.<br /><br />Previous multi-channel experience is a plus.<br /><br />Equal Opportunity Employer<br />We are an Equal Opportunity Employer.<br /><br />Annual Salary Range<br />$40,560 - $47,840<br /><br />The salary range and/or hourly rate listed is a good faith determination that may be offered to a successful applicant for this position at the time of the posting of an advertisement and may be modified in the future. When determining a team member's base salary and/or rate, several factors may be considered as applicable by law including but not limited to location, years of relevant experience, education, credentials, skills, budget and internal equity.<br /><br />#J-18808-Ljbffr