Customer Service - Customer Service Representative (Part Time; Monday-Friday 1-5pm) 105-1067

CommunityCare-posted 3 months ago
Full-time • Entry Level
Tulsa, OK
251-500 employees
Hospitals
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The Customer Service Representative is responsible for being the first point of contact for all membership related questions, requests, and concerns, providing outstanding service to customers. This role involves answering queries regarding customer benefits, eligibility, primary care providers (PCPs), claims, and other related questions. The representative will handle complaints, troubleshoot problems, and provide resolutions in a professional and polite manner to ensure first contact resolution and customer satisfaction. The ideal candidate will be customer-focused, detail-oriented, and results-driven, demonstrating characteristics such as politeness, accuracy, knowledge, teamwork, learning agility, flexibility, and adaptability to change.

  • Process a high volume of incoming inquiries regarding multiple products from members, providers, billing companies, individuals with legal representation, employer groups, and other insurance companies.
  • Strive to achieve first call resolution by communicating accurate information efficiently and timely thereby creating a positive experience for the member.
  • Verify eligibility, benefits, deductible amounts, claim status, copays, coinsurance, and all other information related to a customer and their benefits or a provider and their contract.
  • Use effective listening skills to understand the needs and complaints of the customer to offer them the best possible solution and ensure the member feels supported and valued.
  • Resolve escalated customer issues received from the member, provider, employer groups, or brokers while remaining calm and professional.
  • Provide interpretation services for all product lines via the contracted language line service as appropriate.
  • Work flexible hours, including weekends and evenings, as department or training needs dictate and at the discretion of management.
  • Demonstrate effective problem resolution skills that balance company and customer needs.
  • Adapt to organizational changes including business processes, systems, and technology.
  • Join a team of Customer Service Representatives and build a positive relationship of teamwork, trust, reliability, and excellence.
  • Understand and strive to meet or exceed call center metrics while providing excellent customer service.
  • Participate in training and other learning opportunities to expand knowledge of the company and position.
  • Perform other duties as assigned.
  • Exceptional telephone manner, customer service skills, active listening skills, verbal and written communication skills.
  • Ability to resolve conflict and diffuse tension.
  • Strong time management skills and decision-making skills.
  • Ability to read, comprehend, and explain health insurance benefits in a clear, concise, and professional manner.
  • Ability to work under stress with production and quality standards.
  • Proficient in Microsoft Office applications.
  • Highly organized and attentive to detail.
  • Flexibility and ability to adapt to change.
  • Successful completion of Health Care Sanctions background check.
  • Bilingual skills a plus.
  • Contact center or medical field experience preferred.
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