Customer Experience Administrator

Found in: beBee S US - 3 weeks ago

Honolulu, United States realjobshawaii Full time
Customer Experience Administrator (214268-14)

Provide customer support for a large local business in the health sector

In this position you will play a crucial role in the Customer Service department including managing the acknowledgement and resolution of grievances and appeals from members and providers, resolving member and provider escalations, coordinating and conducting Customer Service training, documenting FAQs, policies and procedures, evaluating and improving operational processes, identifying system/workflow issues and recommending solutions, analyzing call center data, generating weekly/monthly reports, and other related duties to ensure customer service goals are met.

Qualified candidates will have at least three years of customer service experience. A background in the medical/healthcare field is a plus

Hours Full-time, Monday to Friday, 8:00am-4:30pm Location Honolulu, Oahu Pay $60,000 a year Responsibilities
  • Coordinate the timely completion of grievance and appeals process, including acknowledging, researching, and resolving complaints and appeals from members and doctors.
  • Review, research, and analyze claim payments, patient billing and payments.
  • Assist with potential discrepancies in patient billing and/or records to determine corrective action steps.
  • Research, investigate, and report possible situations of fraud and abuse during the investigation of a grievance or appeal.
  • Provide quality training and onboarding for new Customer Service Representatives.
  • Act as the department liaison to Claims Processing, Membership Services, Billing, Professional Relations, Sales, Marketing, Underwriting and/or Information Systems for process/system improvements to enhance the overall customer experience.
  • Develop Job Aids, FAQs, policies, and procedures for the Customer Service department. Update SharePoint to maintain the Customer Service knowledge library.
  • Analyze call center data and generate weekly/monthly/quarterly reports for employer groups and health plans.
  • Assist Customer Service Representatives with escalations and issue resolution for member and provider calls. Contact members and/or providers to follow-up and provide resolution.
  • Serve as a back-up in the daily operations of the Call Center in the event of high call volume, staffing shortages, or to meet performance results.
Qualifications
  • High School Diploma or its equivalent required.
  • Bachelor's degree or an equivalent combination of education, training, or work experience preferred.
  • Minimum 3-5 years of experience in Customer Service, preferably in the areas of servicing customers and providers and researching medical claims payments.
  • Excellent problem solving skills.

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