Customer Services Specialist

Job Description

Job Description

Duties : Job Summary :

This position has the following primary objectives with respect to customer relations for all HAP product lines : (1) Provide followup and courteous and prompt resolution to member inquiries by conducting thorough investigations and fully educating members and customers; (2) Support corporate and departmental goals, member enrollment activities and product implementations; (3) Research, investigate and resolve service failures. Improve the customer experience by identifying root causes, trends and recommend resolutions for service recovery and retention; (4) Educate members and prospective members to promote HAP as the health care coverage of choice.

Duties and Responsibilities :

Respond to inquiries by telephone, mail and in person; research and answer inquiries, complaints and appeals by following all department standards, policies and procedures; direct inquiries to supporting departments for appropriate action and resolution.

Educate existing and potential members on policies, procedures, product offerings, benefit plan and coverage provisions related to all HAP products.

Document all incoming inquiries accurately in to track member inquiry history and trends.

Practice and maintain confidentiality to Privacy and HIPAA regulations.

Proactively seek training and development to enhance skills and abilities.

Monitor workflow inbox and outstanding cases to ensure that all inquiries receive an appropriate response in a timely manner; contact members (by phone / or in writing), as needed, to ensure timely resolution and followup to inquiry.

Interact with support departments in a professional manner to ensure member needs are met.

Develop and maintain strong business relationships with interdepartments; continue to selfeducate on changes in policies and procedures that occur in other departments which could have an impact on department operations and the servicing of member / customers.

Attend training and development sessions or continuing education opportunities offered by Customer Service and maintain enhanced skill levels and performance.

Interact with providers and their staff to obtain information for resolving customer inquiries and complaints.

Ensure and maintain compliance of all department and corporate standards, policies and procedures.

Recommend process improvements based on observations and trends identified while interacting with internal and external customers.

Coordinate and assist with various departmental projects, member enrollment periods, outreach activities and corporate initiatives.

Perform other related duties as assigned.

Skills :

Required Skills & Experience :

Minimum of two (2) years of recent Customer Service or Call Center experience within the last three years.

Must be dependable.

Demonstrate a high degree of integrity, patience, maturity, empathy, tact and Diplomacy.

Demonstrate problem solving skills, flexibility, good judgment and ability to provide service excellence.

Demonstrate the ability to handle assigned projects from start to successful completion including appropriate followup and documentation.

Demonstrate the ability to handle multiple priorities concurrently in a timely and accurate manner.

Demonstrate strong interpersonal, listening, verbal communication and business writing skills.

Demonstrate efficiency in using a PC and various Microsoft programs.

Fundamental understanding of HMO / PPO / POS delivery system and claims billing.

Must be able to work flexible shifts, overtime including evenings and weekends as requested and / or scheduled.

Preferred Skills & Experience :

N / A

Education : Required Education :

Course in Medical Terminology (required completion within six months postemployment).

Associates Degree

OR

A minimum of four (4) years of recent and related work experience in a customer service capacity may be considered in lieu of the degree.

Preferred Education :

N / A

Required Certification & Licensure :

N / A

Preferred Certification & Licensure :

N / A