Customer Support Representative

Looking for a way to make an impact and help people?

Join PacificSource and help our members access quality, affordable care!

PacificSource is an equal opportunity employer. All qualified applicants will receive consideration for employment without regard to status as a protected veteran or a qualified individual with a disability, or other protected status, such as race, religion, color, national origin, sex, sexual orientation, gender identity or age.

Diversity and Inclusion : PacificSource values the diversity of the people we hire and serve. We are committed to creating a diverse environment and fostering a workplace in which individual differences are appreciated, respected and responded to in ways that fully develop and utilize each person's talents and strengths.

Position Overview : Provide excellent customer service primarily by telephone to all PacificSource customers. Assist customers with coverage / claims related questions.

Accurately interpret benefits and policy provisions for all PacificSource products. Conduct appropriate research and follow-up for prompt resolution of disputed claims.

Essential Responsibilities :

• Work efficiently in a high volume call center while maintaining a professional, positive, and caring demeanor.
• Assist callers with coverage related questions / concerns; accurately interpret policy provisions for assigned products.
• Analyze customer's inquiries and determine correct steps for resolution, interpret benefit information, and claims processing accuracy.

Keep resource information up to date and well organized.

• Work efficiently in multiple systems simultaneously while effectively utilizing critical thinking and problem solving skills.
• Document calls in a clear and consistent manner in computer system.
• Conduct appropriate research, take ownership and follow through for prompt resolution of disputed claims.
• Relay information to appropriate departments and personnel using established communication channels and procedures.
• Make outbound calls to members as necessary dependent upon current outreach campaign.

Supporting Responsibilities :

• Meet department and company performance and attendance expectations.
• Be aligned with PacificSource company values.
• Follow the PacificSource privacy policy and HIPAA laws and regulations concerning confidentiality and security of protected health information.
• Perform other duties as assigned.

SUCCESS PROFILE

Work Experience : One-year medical insurance, other healthcare related field, call center or customer service experience required.

CPT / ICD-10 coding preferred.

Education, Certificates, Licenses : High School Diploma or equivalent required.

Knowledge : Basic understanding of insurance and medical terminology, coding and standard medical billing practices preferred.

Proficient computer skills, typing, and 10-key required. Strong written and verbal communication skills.

Competencies

• Building Customer Loyalty
• Building Strategic Work Relationships
• Contributing to Team Success
• Planning and Organizing
• Continuous Improvement
• Adaptability
• Building Trust
• Work Standards

Environment : Work inside in a general office setting with ergonomically configured equipment. Travel is required approximately less than 5% of the time.

Skills :

Accountability, Collaboration, Communication (written / verbal), Flexibility, Group Problem Solving, Listening (active), Organizational skills / Planning and Organization, Teamwork

Our Values

We live and breathe our values. In fact, our culture is driven by these seven core values which guide us in how we do business :

• We are committed to doing the right thing.
• We are one team working toward a common goal.
• We are each responsible for customer service.
• We practice open communication at all levels of the company to foster individual, team and company growth.
• We actively participate in efforts to improve our many communities-internally and externally.
• We actively work to advance social justice, equity, diversity and inclusion in our workplace, the healthcare system and community.
• We encourage creativity, innovation, and the pursuit of excellence.

Physical Requirements : Stoop and bend. Sit and / or stand for extended periods of time while performing core job functions.

Repetitive motions to include typing, sorting and filing. Light lifting and carrying of files and business materials. Ability to read and comprehend both written and spoken English.

Communicate clearly and effectively.

Disclaimer : This job description indicates the general nature and level of work performed by employees within this position and is subject to change.

It is not designed to contain or be interpreted as a comprehensive list of all duties, responsibilities, and qualifications required of employees assigned to this position.

Employment remains AT-WILL at all times.