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Customer Service Representative, Member Svc Call Center

1 month ago

Fulton, United States Rose International Full time

Work Model: Fully Remote (One day onsite to pick up equipment and rest remote)

Qualifications:

HS Diploma or GED required Bilingual Spanish speaking is required for this role Minimum two (2) years of call center or customer service experience required (Healthcare preferred) Candidates have to be within 30 miles of Fulton, MD location

CSR1 Fulton MSCC. Summary: The Customer Service Representative is responsible for increasing customer satisfaction and retention by providing members, customers, patients and providers with accurate, consistent, timely and meaningful information. They will provide support to members' inquiries and issues as they utilize the Client plan and provider services, continuing to build rapport and collaborative relationships with current and prospective members in accordance with compliance guidelines.

Major Responsibilities and Functions:

Available to handle member inquiries regarding: Member Core: Facility Inquiry, Web Support, Promote Client, Order ID Card, Complaint, ID Card Inquiry, Service Review. Member Adv.: Eligibility Inquiry, Benefit Inquiry, General, Complaint, Correspondence Inquiry, Add/Remove Dependent, Service Review, New Member Experience, Internal Regional Request, IVR Defaults. Medicare (For up to two (2) regions.). Premium Billing Enterprise: Billing Inquiry, Make Payment, Complaint, EFT Inquiry, General, Reinstatement Request, Service Review, Client Billing, 1095 Tax Form, SLP* (escalations to Tier 3). Represents Health Plan by answering and documenting all incoming contacts to determine their nature and to respond to complex calls related to specialized product lines or queues. Responds professionally to inquiries from internal/external customers. Initiates contact with the appropriate Health Plan, medical group and facility personnel to obtain information relevant to the concern or inquiry as needed. Evaluates data to determine and implement the appropriate course of action to resolve the complaint and/or coordinate service recovery. Documents according to procedure. Follows established procedures to meet customer/member needs. Required to effectively interact with diverse work units and relevant organizational departments. Has substantial understanding of the assigned skills and applies knowledge and skills to complete a wide range of tasks. Ability to understand relevant policies, processes and customers. Assist the department in meeting customer needs and reaching department expectations. Completes required training and understand how to use tools available to recall necessary information. Develop a full awareness of the way performance and actions affect members and Member Service Contact Centers's (MSCC) performance guarantees (call handling, first call resolution, complaint resolution compliance, member retention, and return contact as warranted). Promotes, ensures and provides customer service to internal/external customers by demonstrating skills which are consistent with the organization's philosophy of providing extraordinary customer relations and quality service. Consistently supports compliance and the Principles of Responsibility by maintains the privacy and confidentiality of information and protects the assets of the organization. Performs other relevant duties as required.

Requirements:

No time off during training and/or first 90 days of assignment. Must be flexible to work weekends and a late shift. Internet must be hardwired and no WIFI accepted Must have strong internet speed and a quiet place for remote work.

Additional Job Details:

It is expected for workers to be in attendance daily during/after training. Training will be 3 months. No time off will be approved.

Shifts during training and nesting as well as productions operation hours.

Fulton- 9/9 (Supporting GA Region):

Training: 8:00 AM - 4:30 PM EST Nesting: 8:30 AM – 5:00 PM EST

Production Operation Hours: ALL LOCATIONS

The Member Service Contact Center (MSCC) operates Monday – Friday 7:00AM – 9:00 PM and Saturday and Sunday 8:00AM to 7:00PM. Pacific Time.

  • **Only those lawfully authorized to work in the designated country associated with the position will be considered.**
  • **Please note that all Position start dates and duration are estimates and may be reduced or lengthened based upon a client’s business needs and requirements.**

Benefits:

For information and details on employment benefits offered with this position, please visit

here . Should you have any questions/concerns, please contact our HR Department via our secure website .

California Pay Equity:

For information and details on pay equity laws in California, please visit the State of California Department of Industrial Relations' website

here .

Rose International is an Equal Opportunity Employer. All qualified applicants will receive consideration for employment without regard to race, color, religion, age, sex, sexual orientation, gender (expression or identity), national origin, arrest and conviction records, disability, veteran status or any other characteristic protected by law. Positions located in San Francisco and Los Angeles, California will be administered in accordance with their respective Fair Chance Ordinances.

If you need assistance in completing this application, or during any phase of the application, interview, hiring, or employment process, whether due to a disability or otherwise,

please contact our HR Department .

Rose International has an official agreement (ID #132522), effective June 30, 2008, with the U.S. Department of Homeland Security, U.S. Citizenship and Immigration Services, Employment Verification Program (E-Verify). (Posting required by OCGA 13/10-91.).