Customer Relations Specialist

Access Health CT•Hartford, CT

15d•Hybrid

About The Position

In a hybrid work environment with 2 days in-office, the Customer Relations Specialist works with the Customer Service team to investigate and resolve issues affecting enrollment of customers in the Access Health CT Exchange system. S/he is responsible for resolving escalated inquiries in which investigation is necessary. Resolutions are based on policy, regulations, and procedures affecting enrollment of customers in the Access Health CT Exchange system. This position has no supervisory responsibilities and reports to a Customer Service Supervisor.

Requirements

BS/BA in a related topic or equivalent experience.
2-3 years of experience in customer service including systems and processes within the health insurance industry preferred
Ability to understand, use and explain complex systems
Thorough understanding of the process and healthcare insurance benefits of the Affordable Care Act and updates on current regulations, as well as the ability to communicate that information
Must achieve a passing score of 80 on online certification exam within the first 2 weeks of hire
Ability to work in a rapidly changing environment
Competent in Microsoft Office system
Excellent communication, interpersonal, negotiation and organizational skills
Strong ability to evaluate complex problems and draw conclusions
Demonstrated strength in developing, documenting, maintaining, and explaining procedures/processes and/or solving problems

Nice To Haves

Bilingual skills a plus

Responsibilities

Serve as first level representative in handling escalated account inquiries that arise directly from the customer or from high profile vendors and stakeholders such as the Governor’s Office, CT Insurance Department (CID), DSS Hearings, Conduent Appeals Department, Public Affairs, Legal Department, and Department Heads
Utilize trained and researched knowledge of the Affordable Care Act (ACA) to resolve issues of a sensitive nature efficiently and accurately
Resolve service problems through clarification of the customer’s complaint, determination of the cause of the problem, selection of the best solution to the problem, explanation to the customer of how the problem will be resolved, expedite correction or adjustment; follow-up to ensure resolution.
Research employer appeals received from the federal exchange and consumer exemptions
Resolve inquiries via phone, email, mail, or social media
Utilize Worker Portal/Admin Tool and utility tool to resolve escalated issues
Log all customer calls according to established procedures and notate all action taken in the Customer Relationship Management (CRM) system
Access other sources for input in resolving an issue. Other sources include but are not limited to, insurance carriers, legal department, or department heads
Act independently in determining appropriate course of action to resolve issues, inquiries, or requests within established timeframes
Verify and investigate general inquires
Serve as point-of-contact to high profile stakeholders throughout resolution process.
Maintain confidentiality of all customer information according to the State of CT’s Ethics policy, AHCT’s Non-Disclosure agreement and AHCT’s Privacy and Security Policy. (ex: Personally Identifiable Information (PII), Protected Health Information (PHI) and Federal Tax Information (FTI))
Act as a Subject Matter Expert (SME) on customer issues resolution
Coordinate with other team members and/or departments to resolve issues promptly
Support operational readiness via system testing support
Attends all team training sessions
Attendance at weekly meetings with the carriers, working directly with the carrier to correct issues that cannot be resolved within AHCT’s application system.
Attend Connecticut Insurance Department (CID) meetings and other outside meetings, as necessary
Educate consumers in the field on the opportunities available to obtain healthcare insurance under the Affordable Care Act
Oversee consumer enrollment process and guiding new store team members through the online process to apply for, reapply for, or change health care insurance coverage using the Access Health CT website
Provide daily statistics to the Field Enrollment Manager
Provide detailed information for issues recurring frequently and offer suggestions for resolution where applicable
Assist durational enrollment specialists when needed during particularly busy times