Customer Service Representative
1 week ago
CCHP Public Portal is seeking a highly skilled and experienced Customer Service Representative to join our team. As a Member Services Representative, you will be the primary point of contact for member inquiries, issues, and requests.
Key Responsibilities:- Provide exceptional service to our members, ensuring that their needs are met in a timely, respectful, and caring manner.
- Research and resolve complex member inquiries and problems, including eligibility verification, benefits, referrals, authorization process and status, complaints, issues with appeals, denials, and claims questions.
- Answer telephone calls promptly and minimize delays that may lead to abandoned calls.
- Inform and educate members on managed care, health plan benefits, and operational policies and procedures and services.
- Correct and update basic enrollment data daily at the time of the member's request.
- Provide Chinese/English language interpretation services when necessary, including assisting with arranging of medical appointments, contacting contracted PBM for prescription issues, and DME exchange/return.
- Contact providers, members, and in-house departments to obtain information and resolve issues.
- Perform initial research of problem claims, pull files, compile necessary information, and forward to proper department for resolution.
- Document all member/provider encounters into the Member Service Inquiry Module.
- Assist the Marketing Department with walk-in prospects by promoting CCHP and answering questions regarding the health plan.
- Alert management of repeat phone calls due to issues that have not been resolved within standards.
- Recommend suggestions for improving workflow and service.
- Exercise discretion in working with confidential information.
- Minimum 1+ years of experience in customer services, call center, or similar.
- Prior experience in health plan experience preferred.
- Fluency in English and Cantonese.
- Excellent oral communication, customer service, and organizational skills.
- Ability to work under pressure in a busy call center environment.
- Attention to detail and willingness to exercise initiative.
- Excellent decision-making, research, and problem-solving skills.
- Ability to deal effectively with difficult and emotional people and issues.
- Able to lift up to 30 pounds.
- Use proper body mechanics when handling equipment.
- Standing, walking, and moving 50% of the day.
- Comply with CCHP Compliance Handbook, including Code of Ethics, and all statutes, regulations, guidelines applicable to federal and state programs.
- Follow guidelines and report suspected violations of any statute, regulations, agreements, or guidelines applicable to all healthcare programs.
Starting salary range: $23.80-$28.62/hour. Salary will be set based on a variety of factors, including internal equity, experience, education, specialty, and training.
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