Summary: Under the supervision of the Customer Support Supervisor, the Customer Support Representative is responsible for answering calls from our clients’ medical provider network and Clients’ enrolled members. The Customer Support Specialist will provide timely and accurate responses in a professional and courteous manner utilizing defined processes and guidelines. This position also assists with various internal tasks that ensure a high level of overall client satisfaction.
Essential Functions:
Responds to provider and member phone inquiries in a timely manner provides accurate responses in a professional and courteous manner
Research inquiries using appropriate team members and Applications as resources
Assists team with providing claim or Plan status for client inquiries
Upon Customer request, modify or add details to the Plan in the Application.
Follows up with provider and member calls to obtain further information internal departments may request, as needed
Ensures that HIPAA guidelines are followed in every communication with providers, clients or staff.
Additional Functions:
Communicates clearly and concisely, with sensitivity to the needs of others
Maintains the confidentiality of all company procedures, results, and information about participants, clients, providers and employees
Maintains courteous, helpful and professional behavior on the job; displays a willingness and ability to be responsive in a warm and caring manner to all customer groups. Consistently cooperates and supports organization in problem solving issue
Establishes and maintains effective working relationships with co-workers
Follows all Policies and Procedures and HIPAA regulations
Participates in any recommended or required training sessions
Maintains a safe working environment
Knowledge, Skills and Abilities required: —
International voice experience voice and non-voice
Educational requirements include a High School Diploma or GED equivalent
Prior customer service experience is required (Inbound or Outbound Calls). Minimum one year of professional work experience in a health plan call center is strongly preferred.
Exposure to health plan management operations is mandatory
Knowledge in Medicare & Medicaid Plans preferred
General knowledge of medical terminology preferred
Knowledge and experience using current computer technology
Working knowledge of Excel and Word
Skilled in establishing and maintaining effective working relationships with clients, and staff at all levels
Skilled in problem resolution; recommends suggestions to increase accuracy and/or efficiency
Ability to work independently with minimal supervision
Ability to communicate professionally, clearly and effectively, verbally and in writing
Ability to prioritize effectively
Ability to multitask
Physical Demands & Other Requirements:
Should be able to work as per the break timings allocated by the supervisor
Should be ready to work in any shift based on business requirements. Should be open to work in US shifts (between 5 pm and 7 am IST)
Remains stationary for extended periods of time
Visual acuity to perform activities such as identifying, inputting and analyzing data on a computer terminal and/or in hard copy
Skills
PRIMARY COMPETENCY : Healthcare PRIMARY SKILL : Healthcare-Contact Center PRIMARY SKILL PERCENTAGE : 100