is broken down in to the following sections; Job Summary, Essential Functions and Secondary Functions. At a minimum Job Summary and Essential Functions are required. See the format below and complete each section in a separate cell. The disclaimer is standard for all regions.
NOTE: If you are not using Secondary Functions, delete the heading provided in the cell.
***1 of 44 openings***
The Customer Services Representative is responsible for the increase in customer satisfaction and retention by providing members, customers, patients and providers with accurate, consistent, timely and meaningful information and prepares them to fully utilize and maximize the benefits of their KP coverage. They also build rapport and collaborative relationships with current and prospective members in accordance with compliance guidelines.
• Available to handle member inquiries.
• Represents Health Plan by answering and documenting all incoming contacts to determine their nature and to respond to complex calls related to specialized product lines or queues.
• Responds with empathy to complaints and concerns from members concerning Health Plan benefits, account status, payment history and medical services.
• Initiates contact with the appropriate Health Plan, medical group and facility personnel to obtain information relevant to the concern or inquiry as needed.
• Evaluates data to determine and implement the appropriate course of action to resolve the complaint and/or coordinate service recovery.
• Documents according to procedure.
• Follows established procedures to meet customer/member needs.
• Required to effectively interact and negotiate with diverse work units at all organizational levels.
• Has substantial understanding of the job and applies knowledge and skills to complete a wide range of tasks.
• Ability to thoroughly understand a large complex organization and its functional policies, processes and customers.
• Assists department in reaching call handling goals, first contact resolution goals, complaint resolution compliance, number retention and making return contact as warranted.
• Completes required training and understand how to use tools available to recall necessary information.
• Effectively diffuses anger, tension and hostility within regulatory guidelines of members expressing concerns about KP.
• Maintains awareness of the way performance and actions affect members and Member Service Contact Center's (MSCC) performance guarantees.
• Open and receptive to feedback and change behavior to improve performance.
• Ability to understand, interpret, act on and direct own work based on analysis of a variety of statistical measurements of individual and contact center performance.
• Promotes, ensures and improves customer service to internal/external customers by demonstrating skills which are consistent with the organization's philosophy of providing extraordinary customer relations and quality service.
• Performs other duties as required.
• In addition to defined clerical requirements, accountable for consistently demonstrating service behaviors and principles defined by the Kaiser Permanente Service Quality Credo, the KP Mission as well as specific departmental/organizational initiatives. Also, accountable for consistently demonstrating the knowledge, skills, abilities and behaviors necessary to provide superior and culturally sensitive service to each other, to our members, purchasers, contracted providers and vendors.
• Consistently supports compliance and the Principles of responsibility (Kaiser Permanente's Code of Conduct) by maintaining the privacy and confidentiality of information, protecting the assets of the organization, acting with ethics and integrity, reporting non-compliance and adhering to applicable federal, state and local laws and regulations, accreditation and licensure requirements (If applicable) and Kaiser Permanente's policies and procedures.
• Two (2) years of customer service experience required.
• High School diploma or equivalent.
• Minimum typing speed of 30 WPM. (Typing test must be current within one (1) year of the posting period. Please contact Human Resources for testing. The typing testing must be completed by the end of the posting period.)
• All internal and external applicants for the Customer Service Representative position are required to pass the job related assessment. (The job-related assessment is for Windows operating system, Microsoft Word, and website navigation, reading comprehension and writing skills, customer service, call center simulation and basic math skills.)
• Excellent written and verbal communication skills.
• Demonstrated analytical and problem-solving skills.
• Basic knowledge of computer systems required.
• Ability to read and respond clearly, effectively and briefly.
• Ability to think critically and problem solve.
• Call Center experience.
• Health Insurance experience.
At Kaiser Permanente, all of us, from accounting, sales and IT, to our care delivery teams on the front lines, stand for Total Health....