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Customer Service Specialist

2 months ago

Rockville, Maryland, United States Staffing Now Full time


As a Customer Service Specialist, you will deliver exceptional support to all participants, local unions, providers, vendors, and fellow customer service representatives through various communication channels including phone, email, and in-person interactions.

In every interaction, your goal will be to provide compassionate and effective assistance.

KEY RESPONSIBILITIES

  • Maintain a comprehensive understanding of the essential plan provisions and various benefit schedules, along with a solid grasp of the eligibility system, claims processing, and the Reciprocity system (ERTS).
  • Respond promptly and accurately to inquiries via phone, email, and in-person, addressing questions, clarifying claim payments and denials, quoting self-payment amounts, verifying eligibility and benefits, and researching any eligibility or claim issues.
  • Accurately document all communications in the Customer Service module.
  • Perform a variety of clerical tasks, including processing enrollment forms, managing working spouse forms, and handling special fund and disability claims.
  • Navigate systems to provide precise information.
  • Monitor incoming calls and manage call queues effectively.
  • Handle messages from the nightline as needed.

ESSENTIAL QUALIFICATIONS
* Minimum of 1 year of experience in a call center environment, particularly in medical billing or insurance, or 1 year of experience in processing medical claims.

  • Bilingual candidates are highly preferred.
  • A Bachelor’s degree or equivalent experience is required.
  • Previous experience with a TPA or major insurance carrier is strongly preferred.
  • Excellent verbal and written communication skills are essential.
  • Proficiency in Microsoft Office is mandatory.
  • Typing speed of at least 40 words per minute is required.
  • Ability to manage complex issues while maintaining a positive and cooperative attitude.
  • Timely responses to operations leaders and stakeholders to support informed decision-making.
  • Ability to troubleshoot issues, gather evidence, and investigate relevant information with participants, vendors, and internal departments to resolve problems collaboratively.
  • Dependability in terms of timely arrival and consistent attendance to support team objectives.
  • Must successfully complete required assessments (Microsoft Office, grammar, and customer service).
* Ability to handle a high volume of calls is necessary.
* Position requires 100% on-site work.

Work Schedule:
Monday to Friday (8 AM - 5 PM)