Customer Service Representative

6 hours ago

Rancho Cordova, California, United States Niahealthcare Full time

Job Summary:

Niahealthcare is seeking a highly skilled and bilingual Customer Service Representative to join our team. As a Customer Service Representative, you will be responsible for providing exceptional service to our members and providers, answering incoming calls, and resolving customer administrative concerns.

Key Responsibilities:

  • Answer incoming calls related to eligibility, benefits, claims, and authorization of services from members or providers.
  • Administer intake documentation into the appropriate systems.
  • Provide outstanding service to internal and external customers and strive to resolve member and provider needs on the first call.
  • Meet or exceed operations production and quality standards.
  • Listen and probe callers in a professionally and timely manner to determine the purpose of the calls.
  • Research and articulate information regarding member eligibility, benefits, EAP services, claim status, and authorization inquiries to callers while maintaining confidentiality.
  • Resolve customer administrative concerns as the first line of contact.
  • Assist in the mentoring and training of new staff.
  • Assume full responsibility for self-development and career progression.
  • Comprehensively assemble and enter patient information into the appropriate delivery system to initiate the EAP, Care, and Utilization management programs.
  • Demonstrate flexibility in areas such as job duties and schedule to aid in better serving members and help Niahealthcare achieve its business and operational goals.
  • Educate providers on how to submit claims and when/where to submit a treatment plan.
  • Identify and respond to Crisis calls and continue assistance with the Clinician until the call has been resolved.
  • Inform providers and members on Niahealthcare's appeal process.
  • Lead or participate in activities that help improve Care Center performance, excellence, and culture.
  • Link or make routine referrals and triage decisions not requiring clinical judgment.
  • Perform necessary follow-up tasks to ensure member or provider's needs are completely met.
  • Provide information regarding Niahealthcare's in-network and out-of-network reimbursement rates and states multiple networks to providers.
  • Refer callers requesting provider information to Provider Services regarding Niahealthcare's professional provider selection criteria and application process.
  • Refer patients/EAP clients to the Niahealthcare's Care Management team for a provider, EAP affiliate, or Facility.
  • Responsible for updating self on ever-changing information to ensure accuracy when dealing with members and providers.
  • Support team members and participate in team activities to help build a high-performance team.
  • Thoroughly document customers' comments/information and forward required information to the appropriate staff.

Requirements:

  • Must be bilingual.
  • Must be flexible in scheduling and comfortable with change as customer service is an ever-changing environment.
  • Responsible for meeting call handling requirements and daily telephone standards as set forth by management.
  • Must agree to observing service for the purpose of training and quality control.
  • Proficient typist (avg. 35+ WPM) with strong written and verbal communication skills.
  • Must be able to maneuver through various computer platforms while verifying information on all calls.
  • Must be able to talk and type simultaneously.

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