Customer Service Representative
Personnel Solutions Unlimited, Inc. Visalia
Call center experience helpful. Act as the primary point of contact and liaison for Foundation, Key Medical Group and delegated health plan members and providers contacting the plan regarding general inquiries, concerns or requests for information.
Develop a general understanding of all member facing materials, communications and interactions and be prepared to respond appropriately to follow up calls. Answer inbound calls and/or place outbound calls in a high call volume environment and work directly with members and providers to accurately and completely answer inquiries involving program services and benefits.
Follow established policies, procedures, guidelines and resources to respond to member and provider inquiries and resolve concerns in an accurate, timely, professional, and culturally competent manner. Intake, handle and coordinate member grievances, appeals and claim issues, escalating to the customer service lead or department manager, when necessary.
Educate members and providers on eligibility, medical and pharmacy benefits and how to access services in a manner that achieves excellent service standards and maintains high customer satisfaction. Use listening skills and judgment to appropriately categorize and accurately document all contacts and follow-up actions regarding member and provider communications and activities in accordance with established guidelines, policies and procedures.
Appropriately handle member and provider requests through alternative channels such as e-mail, voicemail, fax, walk-in, etc. in accordance with established procedures. Triage member and provider requests or inquiries for other departments. Attend and actively participate in daily, weekly, and monthly departmental meetings, in-services, training and coaching sessions.
Develop a general understanding of all member facing materials, communications and interactions and be prepared to respond appropriately to follow up calls. Answer inbound calls and/or place outbound calls in a high call volume environment and work directly with members and providers to accurately and completely answer inquiries involving program services and benefits.
Follow established policies, procedures, guidelines and resources to respond to member and provider inquiries and resolve concerns in an accurate, timely, professional, and culturally competent manner. Intake, handle and coordinate member grievances, appeals and claim issues, escalating to the customer service lead or department manager, when necessary.
Educate members and providers on eligibility, medical and pharmacy benefits and how to access services in a manner that achieves excellent service standards and maintains high customer satisfaction. Use listening skills and judgment to appropriately categorize and accurately document all contacts and follow-up actions regarding member and provider communications and activities in accordance with established guidelines, policies and procedures.
Appropriately handle member and provider requests through alternative channels such as e-mail, voicemail, fax, walk-in, etc. in accordance with established procedures. Triage member and provider requests or inquiries for other departments. Attend and actively participate in daily, weekly, and monthly departmental meetings, in-services, training and coaching sessions.
Identify member/provider issues and trends and report relevant information to the customer service lead or manager. Perform other related duties as required or assigned. Bilingual preferred. Healthcare experience, such as claims, authorizations or benefits.
RandstadFresno, 44 mi from Visalia
A organization that values efficiency, teamwork, is looking for a Customer Service Representative to join their team. If you are organized, and can deliver exceptional customer service for patients and are ready to contribute to a fast-paced work...
Porterville (CA), 26 mi from Visalia
Overview:
As a Customer Service Representative, you’ll build connections and offer a wide range of products and services to our diverse customer base. Our customers are on the go and put their trust in us to provide quick and reliable financial...
Fresno, 44 mi from Visalia
Overview:
At California Check Cashing Stores, we’re more than a financial service provider; we’re a trusted ally for hard-working customers who are seeking quick and reliable financial solutions. As a Customer Service Representative, you’ll play...