Customer Care Associate

2 weeks ago

Richmond, Virginia, United States KEPRO Full time

Position Overview

Kepro is a dynamic and expanding national organization focused on quality enhancement and care management. Our mission is to ensure that millions of individuals receive appropriate care at the right time and in the right environment. We are currently looking for a seasoned professional to join our team.

Role: Customer Service Representative

Job Summary

The Customer Service Representative plays a crucial role in facilitating the prior authorization process. This position involves managing incoming calls, addressing customer inquiries, resolving complaints, and fulfilling requests while adhering to established policies and procedures. A comprehensive understanding of the organization's services is essential to meet productivity and quality benchmarks.

Key Responsibilities

  • Acquire and maintain a thorough understanding of internal policies, procedures, and services.
  • Utilize automated systems for logging and retrieving information, ensuring accurate and timely data entry of electronic communications.
  • Handle inquiries from customers or providers via various communication channels, providing responses within stipulated timeframes.
  • Respond to phone inquiries and complaints promptly, accurately, and courteously, following standard operating procedures.
  • Engage with hospitals, physicians, beneficiaries, and other program participants.
  • Investigate and resolve customer issues or escalate complex situations to the appropriate personnel.
  • Meet or exceed departmental standards for call volume and service levels.
  • Initiate case files by collecting and entering relevant demographic, provider, and procedural information into the system.
  • Act as a liaison between Review Supervisors and external providers.
  • Maintain logs and document the outcomes of incoming and outgoing communications.

The responsibilities listed are not exhaustive and may be expanded to include additional duties as deemed necessary by management.

Qualifications

A high school diploma or equivalent is required. Completion of medical terminology courses is advantageous.

Knowledge, Skills, and Abilities

Knowledge of:

  • Medical terminology
  • Health insurance industry practices

Ability to:

  • Communicate fluently in English over the telephone.
  • Effectively utilize phone systems.
  • Conduct research and investigations.
  • Adhere to confidentiality policies and procedures.
  • Proficiently navigate electronic systems and equipment.
  • Multitask while engaging in telephone conversations.
  • Maintain composure and professionalism in challenging situations.

Skills:

  • Bilingual proficiency in Spanish and English is a plus.
  • Strong verbal and listening skills to deliver courteous and professional customer service.
  • Proficient PC skills, including email and standard industry applications.

Experience:

A minimum of 2 years of customer service or telephone experience in a similar call center environment or industry is preferred.

Mental and Physical Requirements:

The physical demands described are representative of those that must be met by an employee to successfully perform the essential functions of this role. Reasonable accommodations will be made as required by law to enable individuals with disabilities to perform essential job functions. While performing duties, employees are regularly required to sit for extended periods, interact extensively with customers, and occasionally lift or move objects weighing up to 10 pounds.

Kepro offers rewarding career opportunities, competitive benefits, and pathways for professional growth. Interested candidates are encouraged to submit their resume and cover letter outlining their qualifications. Only those selected for an interview will be contacted. No phone calls, please.

EOE AA M/F/Vet/Disability

Kepro is an Equal Opportunity Employer. All qualified applicants will receive consideration for employment without regard to race, color, religion, sex, sexual orientation, gender identity, national origin, disability, or status as a protected veteran.

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