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Customer Service Representative I
2 months ago
Ability to handle irate customers in a courteous, patient, calm and positive manner while maintaining a high quality and quantity of work
Experience in handling high call volume
CA Life & Health license required
If successful applicant does not have insurance license, it is required to obtain one within six (6) months of date of hire
Must have excellent verbal and written communication skills, especially under pressure
Must be computer literate in Microsoft Word, Excel and Outlook
Typing at 55 WPM or more
Must be able to work in a fast-paced environment where deadlines are a priority and handling multiple assignments simultaneously
Problem Solving Skills required
Must have a proficient knowledge of the English language
If hired as a Bilingual representative, Language Assistance Certification is required every two (2) years
Action Oriented, Approachability, Customer Focus, Humor, Listening, Patience, Self-Knowledge, Technical Learning, Time Management, Written Communication
High school diploma or equivalent required
Must be able to sit for extended periods of time and occasional standing and walking
Must have adequate hearing for phone work
Vision requirements include close vision and the ability to adjust focus
Must be able to communicate effectively in English
Must be able to use a keyboard and other office equipment
Ability to lift up to 10 pounds occasionally
Responsibilities
The Customer Service Representative I handles calls from customers to resolve, educate, follow-up and respond to questions regarding California Choice/Choice Builder plan administration and procedures groups, members, brokers and general agencies
Understanding of company policies and procedures as they apply to California Choice/Choice Builder plans
Answers questions by telephone from groups regarding new hires, billings, rates, supplies, administrative procedures, etc
Educates, via telephone, employees/dependents regarding PCP’s, ID cards, RX problems, administrative procedures, dependent coverage, address changes, etc
Follows-up on calls and emails from brokers regarding problems that their groups are experiencing with providers
Ability to interact with brokers, general agents and sales representatives on a daily basis and must be able to answer questions regarding California Choice processes
Responds to calls from providers to confirm eligibility and benefits
Verifies enrollments and resolves issues with carriers
Expedites processing of members enrollment with carrier if urgent services are needed
Review and submit appeal requests from groups
Review /Audit group billing and explain to clients in clear and accurate manner
Document calls in call tracking system
Departmental standard requires each Customer Service Representative to provide Service of Unequalled Excellence to all callers by maintaining an average of 90% or greater on Call Reviews
Answer at least 100% of the daily call volume average
Provide clear and explicit documentation while maintaining percentage at a level of 90% or higher daily
Make busy time of 20 minutes or less per day
Meet department standards for quality and quantity of work
Meet department and team standards for turnaround times
Adhere to all HIPAA (Health Insurance Portability and Accountability Act) and PHI (Personal Health Information) guidelines
On-site or remote regular attendance and punctuality are essential functions of the job
Performs other business tasks or functions as assigned
Qualifications
Ability to handle irate customers in a courteous, patient, calm and positive manner while maintaining a high quality and quantity of work
Experience in handling high call volume
CA Life & Health license required
If successful applicant does not have insurance license, it is required to obtain one within six (6) months of date of hire
Must have excellent verbal and written communication skills, especially under pressure
Must be computer literate in Microsoft Word, Excel and Outlook
Accurate data entry skills a must
Typing at 55 WPM or more
Must be able to work in a fast-paced environment where deadlines are a priority and handling multiple assignments simultaneously
Problem Solving Skills required
Must have a proficient knowledge of the English language
If hired as a Bilingual representative, Language Assistance Certification is required every two (2) years
Action Oriented, Approachability, Customer Focus, Humor, Listening, Patience, Self-Knowledge, Technical Learning, Time Management, Written Communication
High school diploma or equivalent required
Must be able to sit for extended periods of time and occasional standing and walking
Must have adequate hearing for phone work
Vision requirements include close vision and the ability to adjust focus
Must be able to communicate effectively in English
Must be able to use a keyboard and other office equipment
Ability to lift up to 10 pounds occasionally
Responsibilities
The Customer Service Representative I handles calls from customers to resolve, educate, follow-up and respond to questions regarding California Choice/Choice Builder plan administration and procedures groups, members, brokers and general agencies
Understanding of company policies and procedures as they apply to California Choice/Choice Builder plans
Answers questions by telephone from groups regarding new hires, billings, rates, supplies, administrative procedures, etc
Educates, via telephone, employees/dependents regarding PCP’s, ID cards, RX problems, administrative procedures, dependent coverage, address changes, etc
Follows-up on calls and emails from brokers regarding problems that their groups are experiencing with providers
Ability to interact with brokers, general agents and sales representatives on a daily basis and must be able to answer questions regarding California Choice processes
Responds to calls from providers to confirm eligibility and benefits
Verifies enrollments and resolves issues with carriers
Expedites processing of members enrollment with carrier if urgent services are needed
Review and submit appeal requests from groups
Review /Audit group billing and explain to clients in clear and accurate manner
Document calls in call tracking system
Departmental standard requires each Customer Service Representative to provide Service of Unequalled Excellence to all callers by maintaining an average of 90% or greater on Call Reviews
Answer at least 100% of the daily call volume average
Provide clear and explicit documentation while maintaining percentage at a level of 90% or higher daily
Make busy time of 20 minutes or less per day
Meet department standards for quality and quantity of work
Meet department and team standards for turnaround times
Adhere to all HIPAA (Health Insurance Portability and Accountability Act) and PHI (Personal Health Information) guidelines
On-site or remote regular attendance and punctuality are essential functions of the job
Performs other business tasks or functions as assigned
Purpose of Position:
The Customer Service Representative I handles calls from customers to resolve, educate, follow-up and respond to questions regarding California Choice/Choice Builder plan administration and procedures groups, members, brokers and general agencies...
Essential Functions:
• Understanding of company policies and procedures as they apply to California Choice/Choice Builder plans.
• Answers questions by telephone from groups regarding new hires, billings, rates, supplies, administrative procedures, etc.
• Educates, via telephone, employees/dependents regarding PCP’s, ID cards, RX problems, administrative procedures, dependent coverage, address changes, etc.
• Follows-up on calls and emails from brokers regarding problems that their groups are experiencing with providers.
• Ability to interact with brokers, general agents and sales representatives on a daily basis and must be able to answer questions regarding California Choice processes.
• Responds to calls from providers to confirm eligibility and benefits.
• Verifies enrollments and resolves issues with carriers.
• Expedites processing of members enrollment with carrier if urgent services are needed.
• Review and submit appeal requests from groups.
• Review /Audit group billing and explain to clients in clear and accurate manner.
• Document calls in call tracking system.
• Departmental standard requires each Customer Service Representative to provide Service of Unequalled Excellence to all callers by maintaining an average of 90% or greater on Call Reviews.
• Answer at least 100% of the daily call volume average.
• Provide clear and explicit documentation while maintaining percentage at a level of 90% or higher daily.
• Make busy time of 20 minutes or less per day.
• Meet department standards for quality and quantity of work.
• Meet department and team standards for turnaround times.
• Adhere to all HIPAA (Health Insurance Portability and Accountability Act) and PHI (Personal Health Information) guidelines.
• On-site or remote regular attendance and punctuality are essential functions of the job.
• Performs other business tasks or functions as assigned.
Knowledge, Skills & Abilities Required:
• At least two (2) years of customer service experience preferred.
• Knowledge of the health insurance industry and customer service experience preferred.
• Ability to handle irate customers in a courteous, patient, calm and positive manner while maintaining a high quality and quantity of work.
• Experience in handling high call volume.
• CA Life & Health license required. If successful applicant does not have insurance license, it is required to obtain one within six (6) months of date of hire.
• Must have excellent verbal and written communication skills, especially under pressure.
• Must be computer literate in Microsoft Word, Excel and Outlook. Accurate data entry skills a must. Typing at 55 WPM or more.
• Must be able to work in a fast-paced environment where deadlines are a priority and handling multiple assignments simultaneously.
• Problem Solving Skills required.
• Must have a proficient knowledge of the English language.
• Proficient knowledge of the Spanish language is a plus. If hired as a Bilingual representative, Language Assistance Certification is required every two (2) years.
Additional Competencies:
Action Oriented, Approachability, Customer Focus, Humor, Listening, Patience, Self-Knowledge, Technical Learning, Time Management, Written Communication
In addition to the KSAs and Additional Competencies listed above, there are more competencies related to this position. Please refer to the Individual Contributor – Associate competency addendum.
Educational Requirements:
• High school diploma or equivalent required.
Physical Requirements:
Must be able to sit for extended periods of time and occasional standing and walking. Must have adequate hearing for phone work. Vision requirements include close vision and the ability to adjust focus. Must be able to communicate effectively in English. Must be able to use a keyboard and other office equipment. Ability to lift up to 10 pounds occasionally
Company information
The Word & Brown Companies are committed to simplifying access to better health insurance choices – for businesses, employees, and individuals.We are insurance leaders founded on hard work, dedication, and a passion to make health care more accessible. Our organization is comprised of three distinct businesses.Established in 1985, the Word & Brown General Agency is among the largest General Agents in California and Nevada, with a focus on group and individual and family health insurance coverage.CHOICE Administrators is the parent organization for CaliforniaChoice, the nation’s largest multi-carrier, small group private health exchange, and Choice Builder, the nation’s first ancillary benefits exchange.The Companies also offer two no-cost prescription drug discount cards, the California Rx Card and Nevada Drug Card, which deliver savings of up to 75 percent on prescription medications at more than 68,000 pharmacies nationwide.
Insurance, Financial Services, Technology, Healthcare, Payroll Services, Insurance Brokerage, Employee Benefits, Technology Solutions, Employee Benefits Consulting, Employee Benefits Administration
Privately Held
Founded: 1984
Orange, CA
Company Specialties:
Health Insurance, Medicare, Individual & Family Plans, and Small Business Employee Benefits
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