Customer Service Representative - The Health Plan : Job Details

The Customer Service Representative is responsible for answering phone calls in a prompt and courteous manner to achieve contractual obligations. Responsible for answering Member's and Provider's questions with a quick and accurate response. They are also responsible for timely completion of all correspondence and reporting functions associated with the Customer Service Department.

Required:

* High School Graduate or equivalent.

* Strong ability to relate to all customers.

* Excellent communication skills.

* Some knowledge of health care and insurance.

* Computer and Keyboard skills.

* Proper usage of the English Language.

* Consistently displays a positive attitude.?????

Desired:

* 1-2 year post high school education with focus on healthcare.

* Previous call center experience.

* Knowledge of medical terminology.

* Knowledge of CPT and ICD-10 Coding.

* Familiar with medical and hospital claims.

Responsibilities:

* Takes an average of 40-60 incoming calls daily.

* Keep pended work at tolerable range (when applicable).

* Manage to work correspondence, faxes and e-mails in a timely manner.

* Maintains monthly monitoring score of 90% accuracy or above on the 17 Points of Excellence.

* Demonstrates a complete understanding of departmental policies and procedures.

* Able to perform assigned tasks with minimal supervision.

* Meets requirements on annual performance evaluation.

* Increasing improvement in performance and job knowledge.

* Documents calls according to departmental guidelines.