Customer Service Representative

Job Overview :

The Customer Experience Representative provides exceptional support and service to meet the needs of the organization's members and providers. This role involves resolving inquiries, addressing needs efficiently, and embodying the organization’s values in every interaction. The Representative will provide service and product information and identify opportunities to enhance the experiences of members and providers alike.

Key Responsibilities :

• Deliver outstanding service across multiple communication channels (phone, chat, email, and non-phone tasks) to support members and providers, including Medicaid, Medicare, and Marketplace business across various states and products.
• Conduct health assessments and satisfaction surveys related to member / provider experiences.
• Ensure accurate documentation of all relevant details regarding member or provider inquiries.
• Maintain consistent attendance and work scheduled shifts, including breaks and lunches, with the potential for overtime and weekend work as needed.
• Build rapport quickly and empathetically respond to customer inquiries by identifying and surpassing their expectations.
• Listen attentively, capture essential information, and recognize the needs or concerns of members or providers.
• Achieve or exceed personal performance targets for call quality, attendance, adherence, and other contact center goals.
• Actively collaborate and engage with internal and external teams as necessary.
• Take ownership of resolving issues in real-time or through timely follow-ups with members and / or providers.
• Assist providers with basic inquiries regarding member eligibility, covered benefits, the Provider Portal, and the status of claims.
• Communicate professionally and effectively in various settings.

Required Qualifications :

Education :

Knowledge, Experience, Skills and abilities :

Preferred Qualifications :

Education :

Preferred Experience :

Schedule : 40 Hour work week

5-day work week

8-hour days

Availability requirements :

All team members must be available to work any shift, any day of the week during the department’s hours of operation :

Monday – Sunday (Including holidays)

8 : 00 AM – 8 : 00 PM PST