Job Description

JOB SUMMARY:

Under the direct supervision of the Customer Support Center Manager, the CUSTOMER SUPPORT REPRESENTATIVE I (CSR) is the front line support to members, member advocates, and providers. The CSR I provides superior customer service to all incoming callers while assisting with their inquiries and requests. Calls include but are not limited to eligibility verification, authorizations status, PCP changes, appeals, and grievances. CSRs are expected to resolve and/or escalate inquiries/requests and document each call interaction in a clear, concise, professional, and timely manner.

RESPONSIBILITIES:

• Provide superior customer service to all incoming callers to ensure an exceptional customer experience.
• Receive and respond to incoming calls from members, member advocates, providers, health plan representatives, etc. Identify and resolve issues related to patient care and services.
• Assist with inquiries such as eligibility, authorizations status, PCP changes, appeals and grievance intake, and various other inquiries.
• Assist callers in connecting with other internal departments or external parties such as partner PCP offices, health plans, pharmacies, etc.
• Educate callers on the use of the member and provider web portal.
• Properly identify member’s health plan assignments for appropriate re-directing when necessary.
• Collect, verify and update member demographic information in systems.
• Make outbound calls for follow-up purposes when needed. Set reasonable follow-up expectations with callers and meet or exceed those commitments.
• Continuously work on open inquiry log and maintain minimal open cases.
• Use appropriate subject codes, accurately, thoroughly, and clearly document all inquiries in tracking systems.
• Recognize and alert management of inappropriate trends during customer calls. Provide process improvement recommendations.
• Adhere to individual and departmental key performance indicators (KPIs) such as the number of inbound calls per day, wrap-up time, handle time, QA audit performance, abandonment rate, and service level.
• Assist with training of new and existing staff when called upon.
• Actively participate in all departmental meetings, training sessions, and other activities.
• Maintain confidentiality of all protected health information by corporate guidelines.
• Perform other duties as assigned.

REQUIREMENTS:

• High School Diploma or GED required.
• Associates or bachelor’s degree preferred.
• Minimum of 2 years of ACD call center experience required.
• Minimum of 1 year in medical or healthcare environment preferred.
• Bilingual in Spanish required.

SKILLS

• Superior customer service skills with the ability to provide service recovery as needed.
• Ability to communicate professionally, diplomatically, clearly, and concisely, both verbally and in writing with others.
• Ability to answer a high volume of calls in a fast-paced call center environment.
• Strong problem identification and resolution skills.
• Proficient with computer software including Microsoft Office applications (Outlook, Excel, and Word).
• Ability to multi-task, set priorities and pay attention to details.
• Ability to successfully interact with members, medical professionals, health plans, and government representatives.
• Ability to type a minimum of 35-40 words per minute.