JOB SUMMARY 

The Customer Service Representative provides support to providers and members by answering calls regarding eligibility, benefits, claims, and service authorizations. 

DUTIES & RESPONSIBILITIES 

• Answering incoming calls from providers and members
• Provides eligibility, claims and authorization status.
• Retrieves voice mails and responds.
• Collaborates with internal and external partners to resolve issues from providers or members as they relate to claims payment, authorization and eligibility inquiries.
• Creates, tracks and completes Customer Service Incidents to internal departments to resolve caller issues.
• Participate in the discovery and resolution of root cause for recurring issues.
• Ensure that all customer needs and problems are properly communicated and managed in a way that maintains great customer relationships.
• Use customer service best practices to ensure a positive customer experience.
• Meets daily, weekly, monthly metrics as written.
• Other duties and responsibilities as assigned.  

EDUCATION AND PROFESSIONAL EXPERIENCE 

• High School diploma or GED required.
• One (1) to three (3) years in the Health Insurance Industry preferred.
• One (1) to three (3) years of customer service experience required.
• Claims payor experience preferred, but not required. 

PROFESSIONAL COMPETENCIES 

• Strong communication skills, both verbal and written
• Organized and able to prioritize work to meet deadlines
• Able to work independently with little supervision
• Able to thrive in an often-chaotic environment
• Able to understand regulatory and compliance rules
• Results and detail oriented 
• To be positive and accountable
• Team unity focused