Customer Service Professional

2 months ago

Somerville, United States AllWays Health Partners Full time

Job Description - Customer Service Professional (20 hours/week) (3179622) **Job Description**

Customer Service Professional (20 hours/week) ( **Job Number:**

3179622 ) **Description**

The Customer Service Professional (CSP) acts as the primary AllWays Health Partners point of contact for our members, providers and other key stakeholders focusing on exceptional customer satisfaction and first call resolution. The CSPs interact with customers to provide information and troubleshoot complex issues in response to inquiries about coverage, benefits, services, and to handle and resolve complaints.

The person in this role must be committed to building customer confidence and increasing customer satisfaction by delivering to callers an exceptional experience focused on quality and accuracy.

The CSPs will be initially trained on member demographic changes and benefit inquires. Additional member claims training will be delivered 60 days after CSP has completed benefits and eligibility training. After successfully demonstrating core competencies by meeting or exceeding key performance measurements, the individual will be trained to handle Provider claims inquiries as business needs dictate.

**Primary Responsibilities:**

Serve as the primary liaison for members and providers for all lines of business including MassHealth, and Commercial members regarding general program inquires such as eligibility verifications, authorizations, referrals, claims, material fulfillment, address changes and Primary Care Physician assignments as well as member related policy and procedures.

The CSP must be able to handle and demonstrate skills in handling benefits, claims and eligibility calls for the member and provider population.

Identify customer issues/concerns rapidly and precisely

Research required information using available resources and triage when necessary

Handle and resolve customer inquiries and complaints, exhausting all efforts within the CSPs scope before requesting assistance

Identify and escalate priority issues in order to create efficiencies

Initiate follow up customer calls where necessary

Complete call logs to record customer interactions and transactions, recording details of inquiries, complaints, and comments, as well as actions taken

Refer customer grievances and appeals to designated departments for further investigation

Responsible for navigating multiple systems in order to resolve customer issues

Act as the primary representative for AllWays Health Partners for our customers focusing on first call resolution and customer engagement.

Anticipates and meets, or exceeds, internal and/or external customer expectations and requirements; establishes and maintains effective relationships with customers and gains their trust and respect.

Maintain Customer Service Behavior Competencies

Communication

Flexibility/Adaptability/Willingness/Team Player/ Positive Attitude

Relationship Building/Caring

Service Excellence/Accountability/Critical Thinking

**Working Conditions:**

Remote Work Possible

**Qualifications**

**Basic Requirements:**

High School Diploma or equivalent

4+ years in customer service environment

Knowledge of customer service principles and practices

Ability to resolve customers' problems and to demonstrate patience and remain courteous when faced with difficult or angry callers

Ability to work well under pressure and in a rapidly changing environment

**Preferred Qualifications:**

Associates Degree or Bachelors Degree

High school and college level courses in computers, English, or business helpful

Bilingual (Spanish) or other

2+ years in an HMO/Health Care Industry setting

Knowledge of call center telephony and technology

Proficiency with MS Office suite

Understanding of Protected Health Information (PHI) and the necessity to maintain confidentiality of this information

Understanding of or training in Medical terminology

Understanding of medical coding is helpful

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