Customer Service Representative

Independent Health•Buffalo, NY

18d•Hybrid

About The Position

The Customer Service Representative (CSR) is responsible for displaying confidence, passion for service, and practicing empathetic listening while connecting to Independent Health members. The CSR actively listens, assesses needs and utilizes system tools and resources to address and resolve inquiries. In addition, the CSR makes appropriate process or regulatory determinations and follows escalation procedures when deemed appropriate. The CSR is called on to research complex issues pertaining to benefits, claims, plans, and eligibility across multiple databases which requires fluency in computer navigation and toggling while confidently and compassionately engaging with the member.

Requirements

High school diploma or GED required.
Prior experience and success working in a customer service focused environment required.
Excellent written and verbal communication skills.
Ability to communicate with internal and external customers effectively and efficiently.
Must be able to work collaboratively.
Ability to think critically and listen with intent to understand.
Ability to adapt behavior based on constructive feedback to improve job performance.
Proficient in problem solving and ability to prioritize accordingly.
Microsoft Office experience required with the ability to talk and type simultaneously.
Must demonstrate proficiency in balancing keyboard accuracy with speed, the ability to correctly transmit data, and the ability to work efficiently while producing excellent customer service experiences.
Strong organizational and time management skills.
Ability to assume responsibility and maintain confidentiality.
Strong sense of accountability is required.
Flexibility to work additional hours as required by department.
Flexibility in shift assignment required.
Must have availability to work a shift between 8:00 a.m. and 8:00 p.m. during normal business hours.
Weekend shifts and holidays may occasionally be required.
Ability and willingness to meet with customers face to face at alternate locations when business needs require.
Proven examples of displaying the IH values: Passionate, Caring, Respectful, Trustworthy, Collaborative and Accountable.

Nice To Haves

Previous experience working in a call center preferred.
Knowledge of CPT codes, ICD-9 coding, and medical terminology preferred.

Responsibilities

Provide excellent customer service when responding to customers and de-escalate customers as needed.
Relay accurate and up-to-date information on policies and procedures and communicate a successful resolution to inquiries.
Document all calls accurately and timely.
Escalate issues to the appropriate resources as outlined in policy and procedure guides.
Meet or exceed all quality, productivity, accuracy, and call identification goals as stated in the most current departmental policy.
Maintain technical knowledge regarding Independent Health’s contracts and benefits and working knowledge of policies, procedures, and updates daily.
Attend required training sessions as needed (including remote and onsite learning).
Provide accurate and up-to-date information to all customers by documenting all pertinent information into appropriate systems to meet regulatory agency standards.
Utilize multiple systems and tools to obtain needed information related, but not limited to: Claims. Enrollment. Authorizations. Finance. Accounts Receivable. Reference Screens. Providers.
Ability to determine claim status and whether claim is adjudicated properly.
Must have knowledge and ability to make claim adjustments using established criteria.