Customer Service Representative

Description :

THIS POSITION WILL WORK ON THE PROVIDER SIDE. MANAGER IS SEEKING CANDIDATES WITH RECENT 1+ YEARS CLAIMS MANAGEMENT EXPERIENCE

POSITION TITLE : Customer Service Representative I - SHP

LOCATION : Candidate's location will determine if candidate can work on-site, hybrid, or remote (Please be prepared to discuss the speed and reliability of your home internet connection if applying for as a remote position). Facility will accept remote candidates from other locations.

PLEASE NOTE : there is the possibility for contract to hire situation, should the candidate and the need align. Because of this, candidates submitted for consideration MUST have a primary residence / tax home in one of the following states : WI, MI, VA, NC, SC, GA, FL, MS, LA, AR, MO, IA, IN, OH, ND, SD, NE, KS, OK, MT, WY, ID, UT, or NV.

SCHEDULE : Initial training will be 8a-4 : 30p CT. Once training is complete, there is the expectation that candidates will be available to work variable hours between M-F 8-9p Central Time including weekend shifts.

REQUIREMENTS

INTERNET SPEED : Please be prepared to discuss the speed and reliability of your home internet connection if applying for as a remote position.

EDUCATION :

Required : High School Diploma or equivalent; Post High School Education - Vo-Tech or Associate's degree

Prefer candidate to have : Associate or Bachelor s Degree in business administration.

EXPERIENCE

2 years experience with customer service. Demonstrated proficiency with handling high-pressure situations and with verbal and written communication.

1 year Insurance Claims Experience, preferably in a health insurance call center.

CERTIFICATIONS / LICENSES

Preferred / Optional : State of Wisconsin Insurance Agent s license.

JOB SUMMARY

The Customer Service Representative I - Security Health Plan (SHP) primary responsibility is to ensure positive customer interactions with one major product line (Medicare Advantage or Commercial / Marketplace) of Security Health Plan s members. The individual will interact with members, applicants, providers, and agents via telephone. The Customer Service Representative I - SHP will identify the customer s concern and appropriately research and resolve the inquiry in a timely manner. This is a basic learning phase and will be continually trained and coached to enhance customer service skills. The Customer Service Representative I - SHP will escalate complex issues to a Benefit Specialist.

ESSENTIAL JOB FUNCTIONS

1. Provides accurate and timely answers to benefit, coverage, premium and claims questions in person, via telephone to ensure member satisfaction.

2. Assists with coordinating out-of-area or non-affiliated provider referrals for members requiring care outside of the Security Health Plan service area to ensure members receive needed medical care in a timely fashion.

3. Answers Center for Medicare and Medicaid Services (CMS) test calls in an accurate and timely manner to ensure compliance with CMS guidelines.

4. Assists Federally Facilitated Marketplace (FFM) members in updating financial and subsidy information to ensure compliance with the federal government and the Affordable Care Act (ACA).

5. Documents interactions with members electronically to ensure member records are accurate and available for future use of other staff.

6. Utilizes electronic systems to verify and assist members with questions or concerns regarding wellness benefits to ensure members are reimbursed correctly for wellness activities.

7. Troubleshoots online portal and secure email issues for members to ensure they are able to access and view information electronically.

8. Assists members in filing complaints or grievances using internal and / or federal guidelines to ensure complaints are handled and resolved correctly.

9. Participates in continual coaching to maintain call volume, processing metrics and accuracy goals to ensure compliance with accreditation guidelines.

10. Regular attendance is required in order to carry out the essential functions of the position.

11. Reviews and meets ongoing competency requirements of the role to maintain the skills, knowledge and abilities to perform, within scope, role specific functions.

ADDITIONAL DUTIES

1. May be asked to assist with current Medicare Advantage members with plan changes using documented scripts provided by the Centers for Medicare and Medicaid Services (CMS) to ensure members are enrolled in the correct plan.

2. Other duties as assigned.