The Customer Service Representative works under close supervision to provide customer service to our members for our health, dental, and vision plans by performing the following duties. Receives telephone inquiries regarding various aspects of the group health, dental, and vision program such as claims, eligibility, and coverage questions. Educate members on plan benefits, coverage limitations, and coinsurance/deductibles/out-of-pocket maximums using plain, clear language. Protect member privacy and comply with HIPAA and company policies to verify caller and ensure proper documentation is on file before releasing protected health information Maintain accurate record keeping for member providing summary of call, listing any actionable items, creating follow-up tasks when necessary, and indicating resolution of call. Navigate multiple systems while assisting members to search for information in knowledge base system, claims payor systems, and benefits administration system. Conducts research and resolves issues for customer inquiries in a timely manner. Responsible for prepping documents for scanning purposes and handling outgoing mail. Provides additional administrative support for the department. Other testing, projects and duties as assigned related to the job.
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Job Type
Full-time
Career Level
Entry Level
Education Level
High school or GED