General Summary: Under the direction of the Customer Service Management Team, the Customer Service Representative (CSR) is responsible for resolving and responding to telephone and web based inquiries from members and providers. Responsibilities include providing accurate and thorough interpretation of benefits, eligibility, behavioral health referrals, building administrative authorizations for claims payment purposes and assisting callers in accordance with the contract requirements. The CSR will function as a member/provider advocate by meeting or exceeding customers’ expectations. The CSR is expected to take complete responsibility for every interaction with a customer by providing outstanding service as a means to build customer loyalty, improve customer retention and satisfy corporate customer service goals and objectives. The CSR is also expected to promote and coach member and providers in the use of the automated website services available to them for added convenience as an additional way that ValueOptions supports its’ membership .
Essential Duties and Responsibilities:
- Interpret and effectively communicate complex information related to benefits, eligibility, authorization and claims payment in a format easily understood to the customer.
- Maintain professional standards and practice attentive and active listening with a strong focus on establishing a positive rapport with customers.
- Concise, effective accurate and complete documentation of customer interaction to facilitate accurate interpretation of services rendered.
- Demonstrate the company’s commitment to service excellence by providing timely, accurate, and courteous responses to a high volume of telephone, correspondence and web based inquiries from both members and providers.
- Achieve and maintain all required employee performance expectations.
- Thoroughly document all critical information related to customer interactions for accurate tracking and analysis.
- Facilitate customer satisfaction by completely addressing all issues and following through on commitments made to each customer.
- Manage pending inventory and follow up with internal support areas to resolve customer inquiries timely and to escalate issues to management for support in expediting resolution, when necessary.
- Build administrative authorizations as appropriate according to current workflows and procedures.
- Perform complete investigation of customer needs and perform research and analysis in relation to each customer contact, to ensure that rework or additional follow-up from the customer is not necessary.
- Adhere to company standards for attendance, punctuality and schedules. Communicate to the appropriate level of management when adherence is not possible.
- Demonstrate flexibility and respond appropriately to the work challenges and demands when confronted with adversity and other pressures.
- Take responsibility for maintaining an open communication with your manager as related to commitments made.
- Demonstrate an ability to learn new information quickly and effectively, adapt to changes in workflow and work tools.
- Seeks feedback and resources as well as professional learning experiences in order to expand job knowledge and levels of expertise.
- Complete projects and other tasks as assigned by area management.
- Maintain established call quality monitoring standards and apply corrective actions as indicated in quality audits.
- Demonstrate competency in navigating through multiple complex systems
- Resolve all inquiries within the required operational time standards.
- Keep abreast of all system, contractual and policy updates.
- Perform job functions in accordance with Standards Operating Procedures.
- Comply with all regulatory requirements and maintain confidentially in accordance with HIPAA privacy standards.
- Educations: A high school/GED diploma is required. An Associates Degree, advanced coursework or technical education or equivalent related experience is preferred.
- Relevant Work Experience: One year experience in Customer Service, Health Care or Health Insurance is required. Previous experience in an ACD call center environment is preferred.
Value Options - 19 months ago
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