Posted on Jul. 28, 2016
The purpose of the Customer Service Representative is to increase customer satisfaction and retention by providing members, customers and providers with accurate, consistent, timely, and meaningful information. Build rapport and collaborative relationships with current and prospective members in accordance with compliance guidelines.
ESSENTIAL DUTIES AND RESPONSIBILITIES (INCLUDE BUT ARE NOT LIMITED TO):
Be available to handle member inquiries. Represent Health Plan by answering and documenting all incoming contacts to determine their nature, and respond to complex calls related to specialized product lines or ques.
* Respond with empathy to complaints and concerns from members concerning health plan benefits, account status, payment history, and medical services.
* Initiate contact with the appropriate health plan, medical group and facility personnel to obtain information relevant to the concern or inquiry as needed.
* Evaluate data to determine and implement the appropriate course of action to resolve the complaint and/or coordinate service recovery.
* Document according to procedure. Assist department in reaching call handling goals, first contact resolution goals, complaint resolution compliance, member retention and making return contact as warranted.
* Complete required training (including, but not limited to, annual certifications) and understand how to use tools available to recall necessary information.
* Effectively diffuse anger, tension, and hostility, within regulatory guidelines, of members expressing concerns about KP.
* Maintain awareness of the way performance and actions affect members and providers.
* Be open and receptive to feedback, and change behavior to improve performance.
Firstsource Transaction Services, LLC. is an equal opportunity employer that does not discriminate on the basis of age (40 & over), race, color, religion, sex, national origin, protected veteran status, disability, sexual orientation, gender identity or any other protected class in accordance with applicable laws.
KNOWLEDGE, SKILLS AND ABILITIES:
Call center experience preferred. Health insurance experience preferred.
High School diploma or equivalent is required.
Customer service experience preferred.
Minimum typing speed = 30wpm.
Has substantial understanding of the job and applies knowledge and skills to complete a wide range of tasks. Ability to thoroughly understand a large, complex organization and its functional policies, processes, and customers.
Excellent written and verbal skills.
Ability to effectively interact and negotiate with diverse work units at all organizational levels. Demonstrate analytical and problem-solving skills. Basic knowledge of and personal computers required, including experience with Windows based environments. Demonstrate strong reading comprehension and writing skills to analyze and document interaction. Follow established procedures to meet customer/member and provider needs. Demonstrates primary commitment to customer/member and provider needs (before other requirements), intervening and taking immediate action as appropriate. Ability to read and respond clearly and succinctly. Ability to think critically. Excellent written and verbal skills. Demonstrate analytical and problem-solving skills. Ability to understand, interpret, act on, and direct own work based on analysis of a variety of statistical measurements of individual and contact center performance.
To be considered for these positions, candidates are required to successfully complete required skills