Customer Service Representative I

Avera•Sioux Falls, SD

4d•$21 - $27

About The Position

Responsible for providing exceptional service to members and providers of the Avera Insurance Division. The Customer Care Representative will provide customer service to members, providers, groups, and staff by providing accurate and timely responses to inquires regarding eligibility, claims, benefits and appeal rights.

Requirements

The individual must be able to work the hours specified.
To perform this job successfully, an individual must be able to perform each essential job function satisfactorily including having visual acuity adequate to perform position duties and the ability to communicate effectively with others, hear, understand and distinguish speech and other sounds.
High School or GED Equivalent

Nice To Haves

1-3 years related experience

Responsibilities

Operates a multi- line telephone system in a professional and timely manner along with multiple software programs to resolve member, providers, payers, and groups inquiries.
Answer questions, investigate issues, and solve problems in an efficient and responsive manner.
Customer care is provided via web solutions, in person consultation, and telephone.
Provide accurate and consistent communication of policy and procedures to members and providers.
Facilitate member eligibility, entry and termination processes for delegate vendors.
Provide support for other departments with questions, mailings, proofing, and call coverage.
Determine benefit levels for members assigned by policy for specific handling.
Evaluate if claims need to be reprocessed and complete necessary documentation to request an adjustment or refund.
Provide input to customer care leadership regarding ways to perform the position functions more effectively.
Consistently document and report all calls and issues initiated and/or addressed within the customer care department.