Customer Service Rep 1
Jacksonville, FL, United States
Overview
Summary
The Customer Service Representative (CSR) impacts member and providers service experience by handling customer service inquires and problems via telephone, internet, or written correspondence. Customer inquiries are of basic and at times complex nature. The CSR engages, consults, and educates members and providers based their unique needs, preferences, and understanding while using tools and resources available to help guide the customer along a clear path of care. The CSR will deliver exceptional experience to our members and providers.
Responsibilities
ESSENTIAL JOB FUNCTIONS
Key Accountability Metrics
- Handle escalated calls, resolving more complex customer issues in a efficient manner.
- Answer incoming phone calls from customers and identify the type of assistance the customer needs (i.e. benefit and eligibility, billing and payments, authorizations for treatment and explanation of benefits (EOBs)
- Ask appropriate questions and listen actively to identify specific questions or issues while documenting required information in computer systems.
- Intervene with care providers on behalf of the customer to assist with appointment scheduling or connections with internal specialists for assistance when needed.
- Assist customers in navigating websites and encourage and reassure them to become self-sufficient.
- Own problem through to resolution on behalf of the customer in real time or through comprehensive and timely follow-up with the member
- Research complex issues across multiple databases and work with support resources to resolve customer issues and/or partner with others to resolve escalated issues.
- Provide education and status on previously submitted pre-authorizations or pre-determination requests.
- Meet the performance goals established for the position in the areas of efficiency, call quality, provider satisfaction, first call resolution and attendance.
Qualifications
PROFESSIONAL EXPERIENCE/QuALIFICATIONS
Requirements and Must Have Criteria
- 1+ years of Customer Service Representative (CSR) experience OR 1+ years of experience in an office setting, call center setting or phone support role.
- Computer proficiency in windows-based applications. 1+ years working with computer and Windows PC applications, which includes the ability to learn new and complex computer system applications.
- All new hires will be required to successful complete the Customer Service training classes and demonstrate proficiency of the material.
- Ability to work full-time, Monday - Friday between 8:30am - 5:00pm including the flexibility to work occasional overtime given the business need.
Other Personal Characteristics and Experience
- Knowledge of Phone Etiquette
- Strong organizational skills, attention to detail and accuracy
- Ability to work effectively in a team environment and adapt changing priorities, be responsible and reliable.
- Ability to multi-task duties as well as the ability to understand multiple products and multiple levels of benefits within each product.
- Ability to work regularly scheduled shifts within our hours of operation including the training period, where lunches and breaks are scheduled, with the flexibility to adjust daily schedule, and work over-time and/or weekends, as needed.
EDUCATION
- High School Diploma / GED (or higher)
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