Entry level / Online Customer Service Specialist (Remote)

Job Description

The Customer Service Specialist responds to customer service inquiries including, but not limited to benefit information, and timely fulfillment of requests, Providers and Client Representatives. Acting as a liaison with internal and external business partners to provide an exceptional customer service experience.

Essential Functions

• Responsible for providing exceptional customer service, while answering incoming Member and Provider telephone inquiries in a manner that is always respectful and courteous
• Proficient use of proprietary administration systems to respond to customer inquiries and requests adhering to defined customer service standards.(ex. knowledge of in/out of network co-pays, non-plan allowances/retail value as well as the various network relationships)
• Ability to identify and satisfy unique eligibility circumstances (e.g. Member not on file, Member termed and/or split benefits etc.)
• Act as a liaison coordinating efforts between, Member, Provider, Client Representatives and the manufacturing facilities
• Flexibility in work schedule as business needs require
• Ability to identify and perform requirements relative to specialty services (including but not limited to student proof, prior approval, medically necessary contacts, special voucher/authorization processing, and requesting enrollment cards as well as out-of-network requirements) and/or order entry
• Mentor perspective associates and new associates during initial instruction. This involves providing feedback to the hiring management team and trainer
• Ability to probe and identify the critical content of inquiries and route caller as appropriate. Achieve and maintain individual Key Performance Indicators (e.g. quality, adherence to schedule) at acceptable departmental levels while supporting organizational performance measures
• Perform in adherence to the company core values including but not limited to privacy, confidentiality and proprietary company policies and procedures (i.e. HIPAA)
• Participate in any/all training and educational activities necessary to fulfill at least the minimum requirements as specified within your departmental goals. This is in addition to, the completion of any activities necessary for the maintenance of professional affiliations or organizational requirements
• Responsibility for reviewing educational notifications and remaining current on procedural changes
• Regular reliable attendance is required
• Career opportunity with additional training in skills for higher level position which will be considered minimal qualifications should open positions become available
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Education & Experience

• Minimum High School Diploma or GED
• Minimum 1 year of related experience
• Knowledge and experience in the insurance, health, or vision care industry preferred
• Proficiency in Microsoft Office

Skills