Healthcare Inbound Customer Service

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Job description

POSITION SUMMARY:

The Customer Service Representative is responsible for promoting favorable interaction with patients, providers and payers through prompt, accurate and courteous resolution of telephone and written inquiries. This position is primary responsible for inbound calls relating to medical, pharmacy, vision and related healthcare options.

Responsibilities:

• Assist members with questions, complaints and concerns as well as explain policies and procedures
• Receive inbound calls from patients, providers and members; occasionally return calls
• Apply a variety of concepts, best practices and follow policy and procedures
• Provide responses to inquiries and complaints for all phases of operations including billing claims, denials, payments and others
• Explain account situations to ensure member understanding
• Respond promptly to written inquiries or provide call backs from messages
• Aim to resolve inquires on the first call by being proactive and demonstrating product knowledge
• Meet metrics for internal standards
• Escalate advanced issues as appropriate

​Qualifications:

• HS Diploma or equivalent
• 1 years of customer service experience is a medical/healthcare setting including knowledge of medical terminology and working in a production environment
• Demonstrated ability in using a computer which includes expert keyboard and navigation skills and learning new programs
• Solid working knowledge of standard computer applications including MS Word, Excel Outlook and PowerPoint
• Communicate clearly and professionally with internal and external customers
• Work effectively as part of a team to achieve established outcomes. Understand other's roles and empower one another to take responsibility to be successful.
• Demonstrate a collaborative interaction with peers to reach a common goal as well as be a resource to team members and internal/external customers
• Pay close attention to detail in all aspects of the job
• Make decisions using available resources and sound judgment
• Maintain confidentiality and discretion
• Identify and resolve problems in a timely manner, gather and analyzes information skillfully
• Open to other's ideas and exhibits a willingness to try new things
• Demonstrate accuracy and thoroughness; monitor work to ensure quality
• Prioritize and plan work activities to use time efficiently
• Adapt to changes in the work environment, manage competing demands and is able to deal with frequent change, delays, or unexpected events