Client Services Representative II
1 week ago
Customer Support Specialist II
Job Category: Customer Experience Requisition Number: CUSTO01561
Job Overview
Key Responsibilities:
Provide accurate and courteous responses to inquiries from members and providers concerning benefit interpretation, eligibility, claims status, and accessing care through plan providers, as well as other related matters under various health programs.
Facilitate the resolution of issues and complaints by providing relevant information and coordinating necessary actions.
Document inquiries, complaints, and other pertinent data in a computer database in a clear, accurate, and timely manner.
Offer support to other roles and functional areas as needed.
Adhere to customer service attendance and quality standards, consistently striving to enhance customer service skills as demonstrated by the quality of phone interactions.
Ensure first call resolution for customer inquiries.
Actively contribute to the development and maintenance of a cohesive customer service team dedicated to delivering exceptional service.
This position is non-exempt, and punctuality for all scheduled shifts is crucial.
Perform additional duties as assigned; essential functions may be revised at the employer's discretion.
Qualifications
Education:
A high school diploma or equivalent is required; some college or vocational training is preferred.
Experience:
A minimum of 2 years of experience in customer service is required, ideally within insurance, managed care, or a provider setting. Experience in a call center environment is strongly preferred, along with knowledge of claim processing and familiarity with state and federal programs.
Employment Eligibility:
Must successfully complete a criminal background check and not be sanctioned or excluded from participation in federal or state healthcare programs.
Knowledge, Skills, and Abilities:
Preferred knowledge of state and federal programs, particularly Washington Apple Health and Medicare Advantage Plans. Language skills, especially in Spanish and Vietnamese, are advantageous. Understanding of medical terminology and healthcare practices is preferred, along with familiarity with the claims process.
Demonstrated written communication skills, particularly the ability to summarize information clearly and concisely.
Ability to work independently, multi-task, and manage complex assignments effectively while maintaining accuracy and attention to detail.
Exhibit professional courtesy and maintain confidentiality at all times.
Sensory/Physical/Mental Requirements:
Sensory: Ability to speak, hear, and possess near and far vision, depth perception, and peripheral vision.
Physical: Capable of extended periods of sitting, computer use, and occasional standing. Involves simple grasping, fine manipulation, and some lifting (not exceeding 25 pounds).
Mental: Frequent decision-making and the ability to assess data, determine appropriate actions, and provide consultation.
Work Environment:
Office setting with exposure to low-grade radiation from computer monitors; fast-paced with frequent interruptions.
Protected Health Information (PHI) Access:
All information encountered while working is considered confidential. Employees may deal with sensitive material and must adhere to all applicable policies and regulations.
Equal Opportunity Employer:
Community Health Plan of Washington is committed to a diverse and inclusive workforce. All qualified applicants will receive consideration for employment without regard to any protected characteristic.
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