Job description

General Summary:

The Customer Service Representative provides in depth professional, courteous, efficient, timely and accurate resolution to customer phone inquiries. Develops and maintains positive customer relationships and serves as the customer advocate to the company. Serves as primary point of contact for inquiries related to Midlands Choice. Provides timely and accurate support to the re-pricing process by pricing claims that have pended, as well as researching and resolving issues for previously re-priced claims.

Essential Job Functions:

• Provide centralized customer service through inbound interactions, which involves answering queries and resolving issues for members, payers, and providers through understanding of their questions, anticipating their needs, and providing solutions.
• Reprices pended and backlogged claims as assigned meeting established quality and quantity goals.
• Demonstrates knowledge of Midlands Choice business and the healthcare industry by reviewing inquiries, researching root cause, and solving the underlying issues.
• Enhance customer satisfaction and retention through knowledgeable and professional interaction with customers that instills confidence in Midlands Choice, its products and its services. Accesses information from a variety of systems and references in order to provide complete and accurate resolution to customer inquiries.
• Enhance customer satisfaction and retention by assisting customers with understanding company products, services, and processes. Able to proactively communicate with payers, providers and members to resolve outstanding issues.
• Accurately complete documentation of all incoming calls. Identifying the nature of each call and capturing the details of the information communicated to the customer to accomplish this.
• Provide timely service to payer and provider clients by meeting their day-to-day business needs.
• Provide information about on-going customer concerns or trends to management, which includes, but not limited to, suggestions for improvements regarding service issues and procedures.
• Maintains a high level of integrity and discretion during interaction with team members. Lead by Example.
• Consistently maintain all established service expectations and goals for the department including, but not limited to, phone quality, stats and timeliness standards. Involved with or participates in performance improvements.

Knowledge, Skills, and Abilities:

• Knowledge of managed healthcare systems and health insurance industry.
• Knowledge of HIPAA privacy and security protocols.
• Customer focused with the ability to proactively develop customer relationships by listening, understanding, anticipating, and providing solutions to customer needs.
• Ability to problem solve using analytical and independent thinking.
• Ability to use good judgment and sound decision-making based on relevant information and deductive reasoning.
• Ability to resolve issues and conflicts while maintaining composure and confidence.
• Ability to adapt to change and work as a team member.
• Desire for continuous learning and skills improvement.
• Ability to communicate with supervisors, co-workers, customers, and various business contacts in an effective, professional, courteous, and congenial manner.
• Ability to prioritize work and handle multiple tasks/assignments.

Job Type: Full-time

Pay: $15.00 - $20.00 per hour

Benefits:

• 401(k)
• 401(k) matching
• Dental insurance
• Employee assistance program
• Flexible schedule
• Flexible spending account
• Health insurance
• Life insurance
• Paid time off
• Professional development assistance
• Tuition reimbursement

Schedule:

• 8 hour shift

Work Location: Remote

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