Customer Service Representative

The Health Plan of West Virginia Inc•Charleston, WV

13d

About The Position

The Customer Service Representative answers phone calls promptly and courteously to meet contractual obligations, and provides Members and Providers with quick, accurate answers to their questions. The role also includes completing correspondence and reporting functions for the Customer Service Department in a timely manner. The schedule is 8:00 a.m. to 5:00 p.m., 40 hours.

Requirements

High school graduate; 1–2 years of college, preferably with an interest or concentration in a health field.
Strong ability to relate to a variety of people in a non-judgmental manner.
Strong organizational, verbal, and written communication skills.
Some knowledge of the health care system.
Personal computer and keyboard skills.
Proper usage of the English language.
Courteous manner and even temperament.
Excellent communication skills.

Nice To Haves

Previous call center experience.
Knowledge of medical terminology.
Knowledge of CPT and ICD-9/ICD-10 coding.
Familiarity with medical and hospital claims.
Familiarity with prescription coding (NDC).
Familiarity with Coordination of Benefits ruling.
1–2 years of college with an interest or concentration in a health field.

Responsibilities

Answer an average of 40–60 calls daily.
Achieve adequate proficiency in the application used to perform Customer Service Representative functions.
Maintain a monthly monitoring score of 90% accuracy or above on the 17 Points of Excellence.
Demonstrate a complete understanding of departmental policies and procedures.
Perform assigned tasks with minimal supervision.
Meet annual performance evaluation requirements.
Consistently display a positive attitude and acceptable attendance.
Show ongoing improvement in performance and job knowledge.
Document calls according to departmental guidelines.
Complete correspondence and reporting functions associated with the Customer Service Department in a timely manner.
Answer Members’ and Providers’ questions promptly and accurately.