Customer Service Rep II

2 months ago

Seattle, United States Community Health Plan of Washington Full time

** Customer Service Rep II**

**Job Category****:** Customer Experience **Requisition Number****:** CUSTO01561 Showing 1 location **Job Details**

**Description**

**PRINCIPLE DUTIES:**

* Responds accurately and courteously to member and provider inquiries regarding benefit interpretation, eligibility, claims status, accessing care through plan providers, and other related issues under Washington Apple Health, Medicare Advantage Plans and other products as offered by the Community Health Plan of Washington.

* Provides information and facilitate and/or coordinate appropriate resolution of issues and complaints.

* Document inquiries, complaints and other data in computer database in an accurate, clear, and timely manner.

* Provide back-up as needed to other positions and functional areas.

* Meets CS attendance and quality standards. Makes a consistent effort to learn and improve CS skills as measured by the quality of the phone work.

* Provides first call resolution.

* Actively participate in developing and maintaining a cohesive customer service team that is focused on providing excellent customer service.

* Non-Exempt - Reporting to work on time and for all scheduled shifts is essential to this position.

* Other duties as assigned. Essential functions listed are not necessarily exhaustive and may be revised by the employer, at its sole discretion.

**Qualifications**

**Education**

* High school diploma or equivalent required.

* Some college or vocational training preferred.

**Experience**

* Minimum of 2 years of customer service experience required, preferably in insurance, managed care, or a provider setting.

* Experience in a call center environment strongly preferred.

* Claim processing knowledge preferred.

* Experience with state and federal programs (Medicaid, Medicare Advantage Plans) a plus.

Employment Eligibility

* Complete and successfully pass a criminal background check

* Has not been sanctioned or excluded from participation in federal or state healthcare programs by a federal or state law enforcement, regulatory, or licensing agency

Knowledge, Skills, and Abilities

* Knowledge of state and federal programs (Washington Apple Health, Medicare Advantage Plans) preferred.

* Language skills, particularly in Spanish and Vietnamese, a plus.

* Knowledge of medical terminology and healthcare is preferred.

* Knowledge of claim process is preferred.

* Demonstrated written communication skills particularly the ability to summarize notes in a clear, concise manner.

* Flexibility and willingness to work in a matrix-management environment

* Ability to multi-task and deal with complex assignments on a frequent basis

* Perform all functions of the job with accuracy, attention to detail and within established timeframes.

* Meet attendance and punctuality standards

* Demonstrate professional courtesy to others and ability to maintain confidentiality

* Ability to work independently

* Willingness to be part of a fast moving, and dynamic clinical development team

****

**SENSORY/PHYSICAL/MENTAL REQUIREMENTS**

**Sensory***:

* Speaking, hearing, near vision, far vision, depth perception, peripheral vision, touch, smell, and balance.

**Physical***:

* Extended periods of sitting, computer use, talking and possibly standing

* Simple grasp, firm grasp, fine manipulation, pinch, finger dexterity, supination/pronation, wrist flexion

* Frequent torso/back static position; occasional stooping, bending and twisting

* Some kneeling, pushing, pulling, lifting and carrying (not over 25 pounds), twisting and reaching

**Mental**:

* Frequent decision-making. Ability to gather and assess data, determine appropriate actions, apply protocols and knowledge to unique situations, problem-solve and provide consultation.

**WORK ENVIRONMENT**

Office environment with frequent environmental exposure to low-grade radiation from computer monitors; fast paced with frequent interruptions.

**PROTECTED HEALTH INFORMATION (PHI) ACCESS**

All information (written, verbal, electronic, etc.) that an employee encounters while working at CHPW is considered confidential. CHPW employees may encounter protected health information in the regular course of their work at and for CHPW. This position may be exposed to and required to deal with highly confidential and sensitive material and must adhere to CHPW policies, guidelines, and all applicable laws and regulations at all times.

**Candidates whose disabilities make them unable to meet these requirements are considered fully qualified if they can perform the essential functions of the job with reasonable accommodation.*

***Community Health Plan of Washington is an equal opportunity employer committed to a diverse and inclusive workforce. All qualified applicants will receive consideration for employment without regard to any actual or perceived protected characteristic or other unlawful consideration.***

**Qualifications**

**Skills**

**Behaviors**

**:**

**Motivations**

**:**

**Education**

**Experience**

**Licenses & Certifications**

Equal Opportunity Employer/Protected Veterans/Individuals with Disabilities

The contractor will not discharge or in any other manner discriminate against employees or applicants because they have inquired about, discussed, or disclosed their own pay or the pay of another employee or applicant. However, employees who have access to the compensation information of other employees or applicants as a part of their essential job functions cannot disclose the pay of other employees or applicants to individuals who do not otherwise have access to compensation information, unless the disclosure is (a) in response to a formal complaint or charge, (b) in furtherance of an investigation, proceeding, hearing, or action, including an investigation conducted by the employer, or (c) consistent with the contractors legal duty to furnish information. 41 CFR 60-1.35(c)

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