Customer Service Representative I - Apex Health Solutions : Job Details

Description Position Summary The Apex customer service team is responsible for addressing all forms of member and provider inquiries (phone, email, internet and/or written correspondence) in a clear, consistent, professional, and caring manner. The incumbent must be able to demonstrate the knowledge needed to perform all job-related skills and accountabilities as outlined below. Essential Duties and Responsibilities:

• Complies with HIPAA/PHI Regulations.
• Actively all Compliance/Program Integrity requirements.
• Answers benefit, eligibility, claim, network, and authorization inquiries and resolves issues based on phone calls or other inquiry methods from members, providers, and plan sponsors.
• Adheres to schedule, ensuring commitment to meeting department service levels.
• Clearly documents all interactions with members, providers, and other individuals contacting the customer service team.
• Appropriately routes any issue(s) that requires additional internal review to the correct department.
• Correctly transfers callers with complex inquiries to the appropriate team member.
• Respectfully communicates and collaborates with internal and external stakeholders to enhance relationships and render exceptional service.
• Promotes individual professional growth and development by meeting requirements for mandatory/continuing education and skills competency; supports department-based goals which contribute to the success of the organization.
• Research and analyze data to address operational challenges and customer service issues.

Education

• Education: High School Diploma or GED

Work Environment

• Must have reliable transportation.
• You must have reliable transportation and ability to work from home with appropriate internet access and quiet, private workspace.

Qualifications:

• One-two (1-2) years of customer service experience in a call center environment required.
• Medical or health insurance background is required.
• Ability to multitask in a fast-paced environment.
• Proficient computer skills, specifically with Microsoft Office and Windows.
• Ability to interact with various external entities such as health care providers, regulators, clients, brokers, and members, etc.
• Proficient analytical and research abilities to triage issues.
• A desire to serve others while being empathetic with the drive to go above and beyond to help resolve questions at the first point of contact.

About Apex Health Solutions Apex Health Solutions powers payers and providers choosing to engage in value-based risk contracting. Apex's unique solutions create alignment between payers and providers, generating unparalleled value. Combined with Apex's experienced and successful industry leadership, our focal point remains on improvement in patient quality, satisfaction and overall cost of care