Customer Service Representative

In this position, you will be tasked with handling customer applications, maintaining accurate records, resolving customer inquiries, and monitoring customer accounts.

Responsibilities include:

• Responding to incoming phone calls from customers such as members, providers, and facilities in a call center environment
• Identifying and assisting with various customer needs such as benefit and eligibility, billing and payments, authorizations for treatment, explanation of benefits, and claims information
• Utilizing complex computer systems to locate the status of an issue and provide the appropriate response to the caller
• Actively listening and asking relevant questions to identify specific customer questions or issues, while documenting necessary information in computer systems
• Researching complex issues across multiple databases and collaborating with support resources to resolve customer issues
• Partnering with others to resolve escalated issues when necessary
• Striving to meet performance goals in the areas of efficiency, call quality, customer satisfaction, and attendance
• Exhibiting strong communication skills and empathy when interacting with customers
• Utilizing critical thinking skills to problem solve and resolve customer concerns
• Proven experience in Customer Service, preferably in a healthcare setting.
• Demonstrated ability to handle Documentation tasks efficiently.
• Experience in Answering Inbound Calls and addressing customer queries.
• Proficiency in Payment Processing and maintaining accurate records.
• Strong Research skills to gather and interpret relevant data.
• Ability to provide Workstation Support and troubleshoot minor technical issues.
• Understanding of Benefit Functions within the healthcare industry.
• Familiarity with Billing procedures and Claim Administration.
• Experience working in a Facility-based role within the healthcare sector.
• Excellent Communication Skills, both written and verbal.
• Proven track record of achieving high levels of Customer Satisfaction.
• Consistent Attendance and reliability in previous roles.
• Proven ability to Resolve Issues effectively and promptly.
• Experience in processing Authorizations in a healthcare setting.
• Proficiency in using Computer Systems and software relevant to the role.
• Experience working in a Call Center environment.
• Knowledge of Call Center Operations and best practices.
• Ability to work with Offshore teams and coordinate tasks efficiently.
• Excellent Critical Thinking skills and problem-solving abilities.
• Proven ability to Resolve Customer Issues promptly and effectively.
• Demonstrated ability to meet Performance Goals consistently.
• Ability to provide clear Explanation of complex issues to customers.
• Experience in using Multiple Databases and managing data.
• Knowledge of TRICARE and other relevant healthcare systems.