Job Description

  CUSTOMER EXPERIENCE REPRESENTATIVE

JOB CODE  USU D45

FLSA STATUS  NON EXEMPT

EEO

NeuGen is an equal opportunity employer. All qualified applicants will receive consideration for employment without regard to: race, creed, color, gender, national origin or ancestry, age, religion, disability, sexual orientation, gender identity, marital status, pregnancy, genetic information, honesty test results, political or Union affiliation, non-job related arrest or conviction records, membership or record in the National Guard, state defense force, or any reserve component of the military forces of the United States or Wisconsin, for the use or non-use of lawful products off NeuGen’s premises during non-working hours, or any other characteristic protected by local, state, or federal law.

COMPANY OVERVIEW

NeuGen, LLC is a shared Services organization, founded in November 2018, based out of Madison, Wisconsin. In 1970, the not-for-profit WEA Trust was founded by the Wisconsin Education Association Council (WEAC). Well known for high-touch, personalized customer service, WEA Trust serves Wisconsin public employees, their staff, and families throughout the state. In 2018, WEA Trust acquired another Wisconsin-based health plan, Health Tradition, in order to serve both public and private employees in the state. Today, NeuGen supports both health insurance companies in addition to providing medical management and administrative services to other healthcare companies.  

POSITION SUMMARY

POSITION SUMMARY

The Customer Experience Representative is responsible for providing excellent service in response to requests or questions from members/providers; anticipating and proactively informing and educating them on the benefit plans, preauthorization requirements, and network status requirements while sharing any other information relevant to the subject at hand. Representatives will own and research calls to completion and resolution, ensuring member and provider satisfaction.

REQUIRED RESPONSIBILITIES

REQUIRED RESPONSIBILITIES

% OF TIME

• Inbound Member and Provider Inquiries:

• Receive and respond to customer inquiries providing information about the member benefits, eligibility, claims processing and requirements of the benefit plan.
• Inform customers about and facilitate the referral and preauthorization process.
• Contact, inform, and educate members regarding out of network inquiries, non-covered codes or anything that could negatively impact the member experience and/or out of pocket costs.
• Ensure first call resolution through effective call handling and problem solving.
• Determine the various policy provisions, guidelines, provider requirements and procedures, and medical review and other procedures that apply to services.
• Receive inquiries regarding preauthorization of medical and surgical services, including inpatient and outpatient procedures and provide appropriate plan benefit information; providing information regarding approvals and denials of preauthorization requests, or the status of authorizations.
• Provide complete and accurate information about ongoing and changing plans, benefits, network status and preauthorization requirements.
• Access and research various information to provide complete, accurate answers and decisions to customers.
• Investigate and consider all facts and specific circumstances surrounding customer questions and/or concerns and resolve problems accordingly with or without supervisor direction as necessary.
• Document each customer interaction in accordance with the department’s standards, monitor the types of inquiries received, and report trends and concerns to the supervisor/ manager.
• Identify complex or unusual cases that require referral to the Harmony Care Program.
• Inform and educate customers of the information available to them through self-service.
• Improve service by recommending changes to current practices, identifying training needs, and assisting in the implementation of changes.
• Announce and transfer all callers to the after-call survey consistently.

90

• Special Projects and Assignments:

• Perform special projects and assignments compatible with the skills and experience presumed for incumbents in this position, including testing online system changes and enhancements as well as suggesting system improvements.
• Assist with training and orientation of new, existing, and temporary employees on effective use of online systems, portal, references, while demonstrating effective customer service soft skills.

10

REQUIRED QUALIFICATIONS

REQUIRED QUALIFICATIONS

• Three years of experience working in a customer service position or handling customer service inquiries or working in a call or customer care center that required interaction with customers in situations where the customer was not always satisfied.

• High school diploma or GED.

• Knowledge of insurance terminology.

• Communication skills, including the ability to effectively listen and respond to the presented question or concern, pose substantive questions; and edit and compose correspondence and documentation.

• Experience using personal computers, including keyboarding skills, knowledge of Windows-based software; with the ability to efficiently and effectively navigate between different computer programs.

• Excellent performance in present and past positions.

REQUIRED SKILLS

REQUIRED SKILLS

• Ability to speak persuasively, listen, and pose appropriate questions; convey routine and complex information, decisions, and insurance policy provisions.

• Ability to appropriately listen, respond to, and resolve issues for angry, distressed, and/or unreasonable callers.· Ability to compose clear, concise correspondence and narrative reports.

• Ability to document complete and appropriate information into the online systems while speaking on the telephone.

• Ability to identify problems, collect, organize, and analyze information, and make appropriate decisions or recommendations.

• Ability to apply the terms of an insurance policy or contract to a set of circumstances to determine available benefits.

• Ability to accurately apply and perform mathematical functions, including addition, subtraction, multiplication, division, and calculating percentages.

• Ability to work independently and within a team, be adaptive to critical needs, and share expertise as needed.

• Accountable, open, candid, and transparent.

• Ability to be composed and adaptive in a dynamic, fast-paced, customer-focused work environment characterized by rapid change, minimal lead times, and multiple competing priorities.

• Ability to listen and speak on the telephone and write simultaneously.

• Ability to operate telephone system and computer keyboard and printer.

• Commitment to excellence in customer service and the Company’s cultural and other values.

• Commitment to achieving the Company's key results.

WORK REQUIREMENTS

WORK REQUIREMENTS

• Ability to work in typical office conditions

• Ability to type on a computer 100% of the time.

• Dependability, including the ability to meet call center attendance standards.

• Flexibility to work the number and schedule of hours needed to accomplish regular and ad hoc job responsibilities.

PREFERRED QUALIFICATIONS AND SKILLS

PREFERRED QUALIFICATIONS AND SKILLS 

• Knowledge of medical terminology.

• Knowledge of diagnostic and procedure codes.

• Knowledge of provider contracting.

• Experience communicating benefit determinations and rationale to members and providers.

• Experience utilizing Microsoft Word, Excel, and Outlook; HealthRules; Data Dimensions, and other relevant office technologies.

• Experience in the health care industry.

DISCLAIMER

DISCLAIMER

Reasonable accommodations may be made to enable individuals with qualifying disabilities to perform the essential functions of the position.