Group Health Customer Service Representative
Posting will remain active until positions are filled
EOE
Summary
Group Health Customer Service Representative (CSR). We are looking for a Customer Service Representative to provide customer service support to the Group Health Claims Department, Members, Brokers, Clients and Healthcare Providers. Provide prompt, accurate, and friendly customer service. Service can include inquiries regarding members’ health benefit insurance, eligibility, coverage, policy changes and claims submissions. Resolves problems by clarifying the customer's complaint; determining the cause of the problem; selecting and explaining the best solution to solve the problem; expediting correction or adjustment; following up to ensure resolution. The statements contained herein reflect general details to describe the key functions of this job, the level of knowledge and skill typically required, but should not be considered an all-inclusive listing of work requirements. Individuals may perform other duties as assigned, including work in other functional areas to cover absences, to equalize peak work periods or otherwise to balance the workload
Essential Functions:
· Maintain punctuality and attendance as outlined in the Time and Attendance Policy
· Answer incoming calls from members and healthcare providers
o Verification of benefits to include eligibility
o Claim status inquiries
o Flexible Spending Accounting balance inquiries
· Knowledge of ICD 10, CPT/HCPCS coding and descriptions
· Additional duties or projects as assigned by management
Competencies To perform the job successfully, an individual should demonstrate the following competencies:
Adaptability – Adapts to changes in the work environment; manages competing demands; able to deal with frequent change, delays, or unexpected events; changes approach or method to best fit the situation;
Achievement Focus – Measures self against standard of excellence; Recognizes and acts on opportunities
Analytical – Collects and researches data; uses intuition and experience to complement data
Attendance and Punctuality – Is consistently at work and on time; ensures work responsibilities are covered when absent; adheres to Providence’s time and attendance policy
Business Acumen – understands business implication of decisions
Communications – Expresses ideas and thoughts verbally and in written form; must have good command of the English language, oral and written; exhibits good listening and comprehension; keeps others adequately informed; selects and uses appropriate communication methods
Conflict Resolution – Encourages open communications; confronts difficult situations; maintains objectivity; keeps emotions under control; uses negotiation skills to resolve conflict
Continuous Learning – Seeks feedback to improve performance; Pursues training and development opportunities; shares expertise with others
Cooperation – Establishes and maintains effective relations; exhibits tack and consideration; offers assistance and support to co-workers; works cooperatively in group situations; works actively to resolve conflicts
Cost Consciousness – conserves organizational resources
Customer Service – Manages difficult or emotional customer situations; responds promptly to customer needs; responds to requests for service and assistance, meets commitments
Dependability – Follows instructions, responds to management direction; takes responsibility for own actions; completes tasks on time and/or notifies supervisor or manager if needs assistance prior to deadline being missed
Diversity – Shows respect and sensitivity for differences, promotes a harassment-free environment
Ethics – Treats people with respect, keeps commitments; inspires the trust of others; works with integrity and principles; upholds organizational values
Impact and Influence – Pursues and wins support for ideas; displays ability to influence key decision-makers; achieves win-win outcomes; uses authority appropriately to accomplish goals; addresses divergent opinions
Initiative – Volunteers readily as workload permits; asks for and offers help when needed
Job Knowledge – Competent in required job skills and knowledge; exhibits ability to learn and apply new skills; requires minimal supervision; displays understanding of how job related to others; uses resources effectively
Judgment – Displays willingness to make decisions; exhibits sound and accurate judgment; supports and explains reasoning for decisions; includes appropriate people in decision-making process; makes timely decisions
Oral Communication – Speaks clearly and persuasively in positive or negative situations; listens and gets clarification; responds well to questions; demonstrates group presentation skills; participates in meetings.
Organizational Support – Follows policies and procedures; supports organizational goals and values
Personal Appearance – adheres to Providence’s Personal Appearance Policy; keeps self well groomed
Planning and Organizing – Prioritizes and plans work activities; uses time efficiently; plans for additional resources; sets goals and objectives; develops realistic action plans
Problem Solving – Identifies and resolves problems in a timely manner; gathers and analyzes information skillfully; develops alternative solutions; works well in group problem solving situations; uses reason even when dealing with emotional topics
Quality – Demonstrates accuracy and thoroughness; looks for ways to improve and promote quality; applies feedback to improve performance; monitors own work to ensure quality
Quantity – completes work in timely manner; meets productivity standards; ability to work in a fast-paced, multitasked environment; able to efficiently handle workload within set deadlines
Strategic Thinking – Supports strategies to achieve organizational goals
Teamwork – Balances team and individual responsibilities; exhibits objective and openness to other’s views; gives and welcomes feedback in a respectful, professional manner; contributes to building team spirit; puts success of team above own interests; able to build morale and group commitments to goals and objectives; supports everyone’s efforts to succeed.
Use of Technology – demonstrates required skills; adapts to new technologies; ability to adapt to and work in a paperless environment
Written Communication – writes clearly and informatively; edits work for spelling and grammar; varies writing style to meet needs; presents numerical data effectively; able to read and interpret written information.
Qualifications To perform this job successfully, an individual must be able to perform each essential duty satisfactorily. The requirements listed below are representative of the knowledge, skill, and/or ability required. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions.
Education and Experience
· High school diploma or general education diploma (GED)
· 6+ months of customer service and applicable experience
· Strong knowledge Medical Terminology
· Strong knowledge of current ACA guidelines
· Bilingual in Spanish
· Strong attention to detail with time management and decision
· Solid computer, grammar and multitasking skills
· Ability to work comfortably in a fast-paced, high volume call center
Language Skills
Ability to read, analyze and interpret plans, client protocols, medical documentation and government regulations. Ability to write emails, reports, business correspondence and document files clearly. Ability to effectively present information and respond to questions from groups of managers, clients and customers.
Mathematical Skills
Ability to add, subtract, multiply and divide in all units of measure using whole numbers, common fractions and decimals.
Reasoning Ability
Ability to define problems, collect data, establish facts and draw valid conclusions. Ability to interpret a variety of instructions furnished in written, oral, diagram or scheduled form.
Computer Skills
- Ability to learn and utilize industry specific computer software
- Basic knowledge of Microsoft Word and Excel
Work Conditions
The demands described are representative of those that must be met by staff members to successfully perform the essential functions of this job. Reasonable accommodations may be made for individuals with disabilities to perform essential functions.
· May work more than 40 hours per week
· Monday – Friday, 8.5 hour, day shift, one hour lunch; may work weekends and/or evenings based on business needs, with prior manager approval
· Ability to operate computer and other office equipment such as keyboard, phone, copy machine, etc.
· Must be able to remain in stationary position (excluding breaks/lunch)
· The person in this position needs to occasionally move about inside the office to access file cabinets, office machinery, etc.
· Able to perform job in an environment with low to moderate noise and/or level of distractions
· Occasionally move up to 10 pounds
Job Type: Full-time
Pay: $17.00 per hour
Expected hours: 40 per week
Benefits:
- 401(k)
- 401(k) matching
- Dental insurance
- Employee assistance program
- Health insurance
- Life insurance
- Paid time off
- Vision insurance
Schedule:
- 8 hour shift
- Monday to Friday
Experience:
- Medical terminology: 1 year (Required)
- ACA Guidelines: 1 year (Required)
- Verifying Medical Benefits: 1 year (Required)
Work Location: In person