Senior Customer Service Rep

Corewell Health•Saint Joseph, MI

About The Position

Assist and educate members, employer groups, providers, colleagues, and/or Elite agents of health plan benefits with accessing services, facilitating and resolving complex problems, understanding claims, billing and coding, along with other non-routine questions. Consistently serve as a go-to person for others while creating an exceptional experience with each contact, via inbound and outbound calls, face-to-face interactions, online chat, email, etc. Demonstrates high competency in analyzing, evaluating, and responding to complex service inquires from members, providers, employer groups, colleagues, agents, Elite agents, and different customer types across multiple Priority Health products within departmental guidelines. Regularly serve as subject matter expert ensuring professional and pleasant interactions at all times. Partnering with internal and external resources, promptly provides customers with information and education concerning benefit clarification, eligibility requirements, verification, authorization, billing and claim status. Identifies potential trends or issues that impact health plan members and works with coworkers and leadership resources to suggest process improvements. Promptly identifies and resolves or escalates customer concerns or complaints to achieve positive outcomes. Places outbound welcome calls to members to educate them on their benefits as needed. Assists walk-in members and agents if assigned by leadership. Adheres to established procedure and quality guidelines in support of Priority Health service promise, key drivers, performance indicators, as well as Corporate values and codes of excellence. Serves as a role model of exceptional customer service and assists with providing Best Practice benchmarks in procedures. Assists customers with administrative issues, such as submitting enrollment record changes, providing letter explaining coverage or benefits, and obtaining and relaying certain member information to other departments as needed. Facilitates claims resolution through follow-up on member calls and correspondence received to appropriate departments. Effectively tracks and/or documents all service interactions with customers within appropriate systems within guidelines. Also provides direct subject matter expertise to peers and the leadership team through participation in Resource Line, mentoring of newly skilled employees, and committees as assigned. Develops and maintains behaviors of productivity, availability to customers, and adherence to work schedule. As a team member at Corewell Health, you will play an essential role in delivering personalized health care to our patients, members and our communities. We are committed to cultivating and investing in YOU. Our top-notch teams are comprised of collaborators, leaders and innovators that continue to build on one shared mission statement - to improve health, instill humanity and inspire hope. Join a nationally recognized health system with an ambitious vision of continued advancement and excellence.

Requirements

High School Diploma or equivalent
5 years of relevant experience in customer-facing service on phone or face-to-face, focus on positive customer outcomes; customer service and/or managed health care

Nice To Haves

Associate's Degree

Responsibilities

Demonstrates high competency in analyzing, evaluating, and responding to complex service inquires from members, providers, employer groups, colleagues, agents, Elite agents, and different customer types across multiple Priority Health products within departmental guidelines.
Regularly serve as subject matter expert ensuring professional and pleasant interactions at all times.
Partnering with internal and external resources, promptly provides customers with information and education concerning benefit clarification, eligibility requirements, verification, authorization, billing and claim status.
Identifies potential trends or issues that impact health plan members and works with coworkers and leadership resources to suggest process improvements.
Promptly identifies and resolves or escalates customer concerns or complaints to achieve positive outcomes.
Places outbound welcome calls to members to educate them on their benefits as needed.
Assists walk-in members and agents if assigned by leadership.
Adheres to established procedure and quality guidelines in support of Priority Health service promise, key drivers, performance indicators, as well as Corporate values and codes of excellence.
Serves as a role model of exceptional customer service and assists with providing Best Practice benchmarks in procedures.
Assists customers with administrative issues, such as submitting enrollment record changes, providing letter explaining coverage or benefits, and obtaining and relaying certain member information to other departments as needed.
Facilitates claims resolution through follow-up on member calls and correspondence received to appropriate departments.
Effectively tracks and/or documents all service interactions with customers within appropriate systems within guidelines.
Also provides direct subject matter expertise to peers and the leadership team through participation in Resource Line, mentoring of newly skilled employees, and committees as assigned.
Develops and maintains behaviors of productivity, availability to customers, and adherence to work schedule.

Benefits

Comprehensive benefits package to meet your financial, health, and work/life balance goals.
Learn more here.
On-demand pay program powered by Payactiv
Discounts directory with deals on the things that matter to you, like restaurants, phone plans, travel, and more!
Optional identity theft protection, home and auto insurance, and pet insurance
Traditional and Roth retirement options with service contribution and match savings
Comprehensive benefits package to meet your financial, health, and work/life balance goals.
Learn more here.
On-demand pay program powered by Payactiv
Discounts directory with deals on the things that matter to you, like restaurants, phone plans, spas, and more!
Optional identity theft protection, home and auto insurance, pet insurance
Traditional and Roth retirement options with service contribution and match savings