[Hiring] Customer Service Representative I @Word & Brown Companies

Role Description

The Customer Service Rep I handles calls from customers to resolve, educate, follow-up and respond to questions regarding California Choice plan administration and procedures for groups, members, brokers and general agencies.

Essential Functions

• Understanding of company policies and procedures as they apply to California Choice plans
• Answers questions via telephone or email from groups regarding new hires, billing, rates, supplies, administrative procedures, etc.
• Educates, via telephone or email, employees/dependents regarding ID cards, administrative procedures, dependent coverage, address changes, etc.
• Follows-up on calls and emails from brokers regarding problems that their groups are experiencing with providers.
• Ability to interact with brokers, general agents and sales representatives on a daily basis and must be able to answer questions regarding California Choice processes.
• Responds to calls from providers to confirm eligibility and benefits
• Verifies enrollments and resolves issues with carriers.
• Expedites processing of members enrollment with carrier if urgent services are needed.
• Review and submit appeal requests from groups.
• Review /Audit group billing and explain to clients in clear and accurate manner.
• Document calls in call tracking system.
• Ability to work in a paperless environment with the Doc Link system.
• Departmental standard requires each Customer Service Representative to provide Service of Unequalled Excellence to all callers by maintaining an average of 90% or greater on Call Reviews.
• Answer at least 100% of the daily call volume average.
• Provide clear and explicit documentation while maintaining percentage at a level of 90% or higher daily in applicable databases (i.e. Doc Link and Opportunity)
• Make busy time of 20 minutes or less per day.
• Meet department standards for quality and quantity of work.
• Meet department and team standards for turnaround times.
• Adhere to all HIPAA (Health Insurance Portability and Accountability Act) and PHI (Personal Health Information) guidelines.
• On-site or remote regular attendance and punctuality are essential functions of the job.
• Performs other business tasks or functions as assigned.

Qualifications

• CA Life & Health license required. If successful applicant does not have insurance license, it is required to obtain one within six (6) months of date of hire.
• Must have excellent verbal and written communication skills, especially under pressure.
• Ability to handle irate customers in a courteous, patient, calm and positive manner while maintaining a high quality and quantity of work.
• Experience in handling high call volume.
• Must be computer literate in Microsoft Word, Excel and Outlook.
• Accurate data entry skills a must. Computer literate (Windows) and Word Processing Skills (MSWord). Typing at 55 WPM or more.
• Knowledge of the health insurance industry and at least two (2) years customer service experience preferred.
• Must be able to work in a fast-paced environment where deadlines are a priority and handling multiple assignments simultaneously.
• Problem Solving Skills required.
• Must have a proficient knowledge of the English language.
• Proficient knowledge of the Spanish language is a plus. If hired as a Bilingual representative, Language Assistance Certification is required every two (2) years.

Additional Competencies

• Action Oriented
• Approachability
• Customer Focus
• Humor
• Listening
• Patience
• Self-Knowledge
• Technical Learning
• Time Management
• Written Communication

Educational Requirements

• High school diploma or equivalent required.

Physical Requirement

• Must be able to sit for extended periods of time and occasional standing and walking.
• Must have adequate hearing for phone work.
• Vision requirements include close vision and the ability to adjust focus.
• Must be able to communicate effectively in English.
• Must be able to use a keyboard and other office equipment.
• Ability to lift up to 30 pounds occasionally.