JOB SUMMARY: Responsible for accomplishing their primary goal of providing support and rendering Excellent Customer Service by addressing all Health Plan Members calls related to inquiries, questions and concerns in all areas including enrollment, benefit interpretation and eligibility for medical care. Serving assistance to one/maximum two Lines of Business. Maintains confidentiality per HIPAA guidelines..

JOB SPECIFICATIONS AND CORE COMPETENCIES

Essential Functions

• 40% Call Handling: Answer and document Members calls related to inquiries, questions and concerns in all areas including eligibility and status of claims and authorizations. Specifically, have the knowledge and acumen to accurately and concisely provide responses with the primary goal being that Excellent Customer Service is rendered in every connection with our Members.
• 40% Customer Service: Offer Excellent Customer Service through daily phone interaction with Members which is captured during Quality Monitoring.
• 15% Maintains a professional behavior and exhibit excellent interpersonal skills.
• 5% Other Duties as assigned

Reports to Position Title: Customer Svc Center Supervisor


MINIMUM QUALIFICATIONS:

• Education/Specialized Training/Licensure:High School Diploma or GED equivalent
• Work Experience (Years and Area): 1-year Customer Service and/or Health Care / Plan experience in a call center or in a face to face setting.
• Software Proficiencies: Microsoft Office (Word, Excel, Outlook)

Job Family/Job Title Competencies

• Analytical Thinking
• Attention to Detail
• Responding Sensitively