Lead, Customer Service Representative

Regal Medical Group•Los Angeles, CA

4d•$23 - $25

About The Position

This position is responsible for routine audits on individual’s customer service representatives on Customer Service Module and REA/LEAD customers service case, responsible for training the customer service representatives and answers questions relating to eligibility, referrals, provider availability, claims status and department procedures. Handling escalated inquiries from members, Health Plans, providers and employer groups, to provide information and clarification on RMG services.

Requirements

High School Graduate or equivalent required.
3 year experience in medical office, related field, including customer service duties
Ability to deal responsibly with matters of a confidential nature.
Ability to prioritize work in order to meet daily deadlines.
Must have excellent communication skills, both verbal and written.
Ability to read, write and understand the English language.
Pleasant telephone manner.
Working knowledge of MS Word.
Working knowledge of MS Excel.
Working knowledge Outlook (email & calendar)
Working knowledge of Cisco phone system
Ability to operate PC based software programs or automated data base management systems
Thorough knowledge of company internal policies and procedures relating to service, medical management, eligibility and claims.
Training experience in handling sensitive situations for members

Responsibilities

Receives incoming calls involving multiple issues from members, Health Plans and providers maintain quality and productivity standards
Conduct and maintain quality assurance progress reports, conduct Q&A reviews by listening to recorded calls and providing training and feedback as necessary
Audit documentation for accuracy of the customer service module and REA/LEAD Customer Service Cases
Audit customer service incident reports for RMG, LMG, GCMG and ADOC for timeliness
Conduct weekly procedural training meetings with customer service representatives to address current issues that impact the CSC department, interact with leadership group to aid in overall staff development and training
Attend daily and weekly meetings with supervisors and department manager and provide written status and progress reports.
Researches and resolves routine and complex issues relating to services provided by RMG,LMG GCMG and ADOC. This can include eligibility updates, referral status, claim status, and general information.
Trains new customer service employees and answers questions relating to eligibility, referrals, provider availability, claims status and department procedures
Facilitates the processing of telephone appeals, inquiries or complaints, statement of concerns for the member by accurately and timely collection of information
Work independently and make Auditor/Team Lead decisions when necessary.
Handle a multitude of assignments and prioritize work in order to maintain workflow.
Provide assistance and mentoring to other customer service representatives or personnel as needed.
Ensure written and verbal communication with all levels of management, staff, vendors and property management or accurate and with good grammar.
Maintain confidentiality with all information pertaining to the members medical information
Have the required ability to operate well in a call center team environment as a team leader.
Have a very strong knowledge of customer care techniques and processes.
Documentation such as general reports on each team member’s performance and targets as well as ensuring that they exceed the targets
A team leader has the responsibility to motivate and inspire once the peer’s team to surpass their potential as much as possible.