Simplifying Access to Better Health Insurance Choices
Customer Service Representative I
Location
California
Posted
19 hours ago
Salary
$20 / hour
Seniority
Mid Level
Job Description
Customer Service Representative I
The Word & Brown Companies
• Understanding of company policies and procedures as they apply to California Choice/Choice Builder plans. • Answers questions by telephone from groups regarding new hires, billings, rates, supplies, administrative procedures, etc. • Educates, via telephone, employees/dependents regarding PCP’s, ID cards, RX problems, administrative procedures, dependent coverage, address changes, etc. • Follows-up on calls and emails from brokers regarding problems that their groups are experiencing with providers. • Ability to interact with brokers, general agents and sales representatives on a daily basis and must be able to answer questions regarding California Choice processes. • Responds to calls from providers to confirm eligibility and benefits. • Verifies enrollments and resolves issues with carriers. • Expedites processing of members enrollment with carrier if urgent services are needed. • Review and submit appeal requests from groups. • Review /Audit group billing and explain to clients in clear and accurate manner. • Document calls in call tracking system. • Departmental standard requires each Customer Service Representative to provide Service of Unequalled Excellence to all callers by maintaining an average of 90% or greater on Call Reviews. • Answer at least 100% of the daily call volume average. • Provide clear and explicit documentation while maintaining percentage at a level of 90% or higher daily. • Make busy time of 20 minutes or less per day. • Meet department standards for quality and quantity of work. • Meet department and team standards for turnaround times. • Adhere to all HIPAA (Health Insurance Portability and Accountability Act) and PHI (Personal Health Information) guidelines. • On-site regular attendance and punctuality are essential functions of the job. • Performs other business tasks or functions as assigned.
Job Requirements
- At least two (2) years of customer service experience preferred.
- Knowledge of the health insurance industry and customer service experience preferred.
- Ability to handle irate customers in a courteous, patient, calm and positive manner while maintaining a high quality and quantity of work.
- Experience in handling high call volume.
- CA Life & Health license required. If successful applicant does not have insurance license, it is required to obtain one within six (6) months of date of hire.
- Must have excellent verbal and written communication skills, especially under pressure.
- Must be computer literate in Microsoft Word, Excel and Outlook. Accurate data entry skills a must. Typing at 55 WPM or more.
- Must be able to work in a fast-paced environment where deadlines are a priority and handling multiple assignments simultaneously.
- Problem Solving Skills required.
- Must have a proficient knowledge of the English language.
- Proficient knowledge of the Spanish language is a plus. If hired as a Bilingual representative, Language Assistance Certification is required every two (2) years.
Benefits
- Health insurance
- Paid time off
- Professional development opportunities
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