Government Programs Customer Service Representative

Job Overview

JOB DETAILS

REQUIREMENTS

• Employees must have the ability to work an assigned eight (8) hour schedule starting as early as 7:55 a.m. and ending as late as 11:00 p.m., Monday through Friday

• Possess a high school diploma or equivalent, with an associate’s degree in business administration or a related field preferred

• Two years of customer service experience in a business environment that requires the use of a software application to assist customers, preferably in a call center assisting Medicare and/or Medicaid enrollees

• Demonstrated knowledge of personal computers and software applications (including Windows) through previous experience and/or coursework

• Successful completion of the customer service simulation assessment with a minimum score of 62 out of a possible 100 (assessment waived if candidate previously passed test while at Delta Dental or if previously held Customer Service Trainee, Customer Service Advisor, or Customer Service Associate position)

• Successful completion of the customer service multitasking and call logging assessment with a minimum score of 65 out of a possible 100

• Successful completion of the customer service email composition assessment with a minimum score of 62 out of a possible 100

RESPONSIBILITIES

• Promptly and professionally responds to member, client and provider questions through multiple channels, including, but not limited to telephone, email, fax and U.S. mail communication using proper etiquette, grammar, punctuation, etc.

• Clearly and accurately communicates all eligibility, benefit, claim status and payment information related to caller’s questions

• Properly identifies the reason(s) for the call and provides appropriate resolution to inquiries and complaints within specified timeframes and guidelines established by regulatory agencies or client contracts.

• Informs and assists callers with grievance and the claims appeals processes, as necessary

• Clearly, accurately and thoroughly documents information in the customer relationship management system to ensure all relevant details of the phone call are captured.

• Understands the importance of adhering to regulatory requirements

• Meets or exceeds quality standards as required for position

• Meets or exceeds call center metrics as required for position

• Enters and adjusts claims as required

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