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.