Customer Service Representative
HealthNow New York Inc. - Buffalo, NY

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Full Time and Part Time Customer Service Representatives

Various Schedules Monday - Friday.

Must be available for classroom training for four weeks from 8:30am - 5pm.

Position Summary: Provides quality customer service in a high volume contact center to include providing complete, accurate and timely responses to inquires from subscribers, members, providers, internal and external customers; Adjusts claims.

Primary Job Duties:
  • Responds to and resolves inquires from subscribers, members, groups, other plans and other departments:
    • Communicates and interacts with internal and external customers in a clear, unambiguous, concise, professional and empathetic fashion.
    • Handles all inquiries and services incoming and outbound calls and correspondence.
    • Considers all aspects or elements in a logical manner; considers contractual provisions and options to resolve inquiry; communicates with internal and external customers.
    • Utilizes and interprets appropriate reference materials and other necessary resources in responding to inquiries.
    • Communicates with internal and external customers via phone, personal contact (lobby walk-ins), email, online chat or in writing; utilizes Letter Reference Guide (LRG) templates as necessary.
    • Takes ownership of problems and establishes relationships with customers meeting all corporate guidelines.
    • Demonstrates an ability to communicate the contract benefits and requirements to the customer; communicates pros and cons of various plan benefit differences.
    • Coordinates with Marketing and Enrollment staff and other internal and external entities.
  • Pursues, researches, tracks and follows up on information regarding claim benefits, eligibility and all other aspects of business:
    • Acts as front line contact for company, identifies potential problems and inconsistencies and corrects to prevent ongoing or future problems; recommends and forwards to Sr Service Representative and/or Management for review.
    • Researches, prepares responses and provides supporting documentation. Identifies potential fraud cases and forwards to Special Investigations Unit.
  • Adjusts claims: Performs online transactions and/or adjustments. Determines claim disposition by reviewing correspondence and claim inquiry history; follows desk levels, standard operating procedures.
  • Performs all job duties efficiently, accurately and at an acceptable level of performance.
  • Performs related clerical duties: Files, faxes, copies documents.
  • Maintains confidentiality and adheres to HIPAA regulations.
  • Delivers customer service in a professional, polite and efficient manner.
  • Performs other duties of a similar nature that are not inconsistent with this position or pay grade.

Required Skills

Primary Skills/Knowledge:
  • Must meet qualifications to perform the job including satisfactory completion of all training and testing
  • Customer Service Representative job content tests
  • Ability to multitask in fast paced environment
  • Well organized with ability to adapt to changing office environment; exhibits attention to details and time management skills
  • Proficiency in English language skills, including spelling, punctuation and grammar, in both written and verbal communication to ensure communications are issued in a professional manner
  • Ability to effectively communicate in both written and verbal communication with internal and external contacts, in a professional manner
  • Working knowledge of personal computer and application software such as Microsoft Office
  • Ability to utilize basic office equipment including PC, scanner, telephone, copier, printer, fax, calculator
  • Computer Software typically used: Content Manager, Facets/Streamline, PEGA, OnDemand

Required Experience

Education: HS/GED

Experience: Two (2) years Customer Service related experience in a high volume call/contact center

Working Conditions:
  • Must be able to work in an office environment
  • Physical Effort: Minimum; typical of most office work. Mostly sedentary work.
  • Weight: Occasionally lift/carry under 10 lbs.
  • Prolonged Sitting
  • Repetitive Motion
  • Manual Dexterity Req: Eye-hand coordination and manual dexterity sufficient to effectively utilize various office equipment (phone, computer, fax machine, printer, copier, filing cabinet, etc)
  • Manual Dexterity Req: Eye-hand coordination and manual dexterity sufficient to effectively use a computer with all its components for prolonged periods of time and for the majority of required tasks
  • Vision Req: Close vision (clear vision at 20 inches or less)