Call Center Customer Service Representative - REMOTE - MUST HAVE CALL CENTER EXPERIENCE.
Central and Mountain time zones preferred!
Training Schedule: 8:00am-4:30pm Central Standard Time (4-6 WEEKS)
Work Schedule: 10:30am-7:00pm Central Standard Time
Mush have high speed internet and be able to plug directly into your router.
Laptop and monitor provided.
Description
⦁ This position is 100 percent remote and part of an operations team that strives to provide first call resolution to a specified set of customers.
⦁ You will be responsible for primarily answering incoming calls for new and existing authorizations
⦁ Other responsibilities include documenting in the appropriate systems and ensuring high quality
and accurate information is provided to callers.
⦁ It is designed to start as a contract role for approximately 5-6 months with the potential to convert into a full-time opportunity depending on your performance and the business needs.
What You’ll Be Doing
• Understand the end-to-end authorization process, and the business drivers for success.
⦁ Actively listen and probe callers in a professional and timely manner to process authorizations
and/or other customer service requests working towards first call resolution.
⦁ Research and communicate information regarding member eligibility, provider status and
authorization inquiries to callers while maintaining confidentiality.
⦁ Resolve customer complaints or concerns as the first line of contact.
⦁ Make problem resolution and triage decisions not requiring clinical judgment.
⦁ Discourage unnecessary clinical/physician phone transfers and encourage medical records to be
submitted. Help callers understand what clinical information is required.
⦁ Transfer calls to clinicians and physicians only for clinically escalated situations.
⦁ Communicate appeal and denial language to providers and members when appropriate.
⦁ Process withdrawals and other case status changes as needed.
⦁ Understand client and regulatory expectations for accounts in their designated region.
⦁ Recognize and develop relationships with provider groups through repeat calls and provider
sensitivities for different health plans.
⦁ Is responsible for reading and retaining information disseminated through multiple resources,
ensuring calls are handled accurately and appropriately per current account information.
⦁ Process fax attachments in between calls.
⦁ Responsible for meeting Service standards in all categories monthly, be a team player, always
maintain member and provider confidentiality, demonstrate effective problem-solving skills, be
punctual, and maintain good attendance.
⦁ Participate in Service Operations activities as requested that help improve Care Center
performance, excellence, and culture.
⦁ Support team members and participate in team activities to help build a high-performance team.
⦁ Demonstrate flexibility in areas such as job duties and schedule to aid Customer Care Operations
in better serving its members and help achieve its business and operational goals.
⦁ Assist efforts to continuously improve by assuming responsibility for identifying and bringing to the attention of responsible entities operations problems and/or inefficiencies.
⦁ Assume responsibility for self-development and career progression.
The Experience You’ll Need - Required!
⦁ High school diploma or GED
⦁ At least 1 year call center experience
⦁ Ability to handle a heavy call volume of 50-100 calls daily
⦁ Ability to maintain strict confidentiality of protected health information
⦁ Demonstrated ability in using computer and Microsoft applications, which includes strong keyboard and navigation skills, ability to type 35 WPM and learn new computer programs
⦁ Ability to work regularly scheduled shifts within hours of operation including the training period,
where lunches and breaks are schedule.
⦁ Demonstrated ability to take an educative approach, listen skillfully, collect relevant information,
determine immediate requests and identify the current and future needs of the customer, answering questions and informing of health plan policies, procedures, or decisions
Additional Experience that is Preferred
⦁ 2+ years at a health plan, TPA or related call center setting
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