Customer Service Representative 1

2 weeks ago

Bakersfield, United States Heritage Provider Network Full time
Job Description

Under the direction of the Director of UM and CS, this position is responsible to respond to inquiries from members, providers and health plan representatives regarding plan benefits, plan policies, claims issues, authorization inquiries, and facilitate appropriate resolutions. The representative will have daily and extensive contact with customers to resolve complex issues, interpret policies/procedures, benefits, and respond to requests for services. The Level IICustomer Service Representative will interact with other departments, clinic personnel, and outside providers in a professional and friendly manner, to create and maintain a positive relationship with our internal and external customers.

  • Answer inquiries related to member plan benefits, network providers, and account related questions.
  • Work directly with members, service providers and health plans to identify and resolve health care service concerns.
  • Embrace ongoing personal development through regular training which helps to enhance one's own technical problem-solving skills.
  • Respond to questions with detailed and expeditious follow-up to promote accurate and timely processing of issues.
  • Employ effective communication methods to promote positive and productive public relations with members, providers, health plan representatives and other departments.
  • Identify, investigate, resolve, and report member and provider issues to appropriate department and/or management when necessary.
  • Promote a high standard of member satisfaction and access to medical care by documenting feedback from member
  • Maintain detailed documentation of all interactions with members, providers and health plan representatives byappropriately coding and logging in systems utilized while maintaining confidentiality in accordance with established policies and regulations.
  • Identify members using at least 4 key verification HIPAA elements (name, date of birth, address, phone number,primary care physician and/or member ID).
  • Communicate with corresponding departments in regard to any changes on a members file and/or health record.
  • Adhere to all call metrics as set forth by HPN.
  • Verify eligibility by researching and providing current plan information requested by members and providers ensuring that the information is accurate.
  • Assist management staff in completing customer service-related special projects.
  • When necessary or as requested, forward complex or escalated calls to a Level 11 CS Representative or CS Management.
  • Demonstrate ability to navigate through multiple computer applications, effectively research and identify solutions using computer-based resources with speed and accuracy.
  • Demonstrate the ability to relate to customers in a professional and courteous manner.
  • Exhibit excellent attention to detail and ability to multi-task.
  • Maintain the ability to demonstrate empathy, patience, adaptability, and a strong positive work ethic.
  • Ask appropriate questions and listen actively to identify specific questions or issues while documenting required information in computer systems.
  • Communicate and collaborate with members and providers to resolves issues, using clear, simple language to ensure understanding.
  • Exhibit the ability to translate healthcare-related jargon and complex processes into simple, step-by-step instructions a member or provider can understand and act upon.
  • Due to role within the organization, you may be monitored or recorded.
  • Complete HPN compliance training annually.
  • Complete Language and Cultural Linguistics training annually.
  • Perform other job-related duties as required.
Requirements
  • High School graduate or GED certification, required.
  • One-year recent experience in customer service-related field with a high degree of problem solving and decision making, preferred.
  • One-year of healthcare call center experience, preferred.
  • Typing certificate of at least 40 wpm, required.
  • Proficient written and oral communication skills.
  • Demonstrate good judgement.


The pay range for this position at commencement of employment is expected to be between $22.58 and $26.56 however, base pay offered may vary depending on multiple individualized factors, including market location, job-related knowledge, skills, and experience.

If hired, employee will be in an "at-will position" and the Company reserves the right to modify base salary (as well as any other discretionary payment or compensation program) at any time, including for reasons related to individual performance, Company or individual department/team performance, and market factors.

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