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Customer Service Representative

2 months ago

Houston, Texas, United States Apex Health Solutions Full time
Job Summary

We are seeking a highly skilled and compassionate Customer Service Representative to join our team at Apex Health Solutions. As a key member of our customer service team, you will be responsible for providing exceptional service to our members, providers, and plan sponsors.

Key Responsibilities
  • Compliance and Regulatory Adherence
    • Ensure compliance with HIPAA/PHI regulations and all relevant healthcare laws and guidelines.
    • Adhere to all compliance and program integrity requirements.
  • Customer Service and Support
    • Respond to benefit, eligibility, claim, network, and authorization inquiries from members, providers, and plan sponsors.
    • Resolve issues in a timely and professional manner.
  • Scheduling and Documentation
    • Adhere to a schedule to ensure commitment to meeting department service levels.
    • Clearly document all interactions with members, providers, and other individuals contacting the customer service team.
  • Issue Resolution and Routing
    • Route issues that require additional internal review to the correct department.
    • Transfer callers with complex inquiries to the appropriate team member.
  • Communication and Collaboration
    • Communicate respectfully and collaboratively with internal and external stakeholders to enhance relationships and render exceptional service.
  • Professional Growth and Development
    • Promote individual professional growth and development by meeting requirements for mandatory/continuing education and skills competency.
    • Support department-based goals that contribute to the success of the organization.
  • Data Analysis and Research
    • Research and analyze data to address operational challenges and customer service issues.
Requirements
  • Education
    • High School Diploma or equivalent required.
  • Work Environment
    • Must have reliable transportation.
    • Must have reliable transportation and ability to work from home with appropriate internet access and quiet, private workspace.
  • Qualifications
    • One-two years of customer service experience in a call center environment required.
    • Medical or health insurance background required.
    • Ability to multitask in a fast-paced environment.
    • Proficient computer skills, specifically with Microsoft Office and Windows.
    • Ability to interact with various external entities such as healthcare providers, regulators, clients, brokers, and members, etc.
    • Proficient analytical and research abilities to triage issues.
    • A desire to serve others while being empathetic with the drive to go above and beyond to help resolve questions at the first point of contact.
    • Must have a strong work ethic and a sense of responsibility to other team members and external stakeholders to meet all needs represented by a robust sense of accountability.
    • Flexible to work evenings, weekends, and/or holidays.
    • Adaptable and a quick learner, willing to change to meet shifting customer and business needs.

The above job description is not intended to be an all-inclusive list of duties and standards of the position. Incumbents will follow any other instructions, and perform any other related duties, as assigned by their supervisor.