Customer Service Representative (Medical)
Menasha, WI 54952
Seeking a Customer Service Representative who will support all lines of business, (Medicare, Commercial, HIX and Health Promotion) for benefit interpretation, claims, authorizations and member inquiries. This individual will receive telephone inquiries from Members, Agents and Providers and meet with walk-in members as needed. Performs outbound calls to members for relationship management and specific issue resolution. Provides excellent service to internal and external customers through a demonstrated commitment to our Mission and Values.
Essential Duties and Responsibilities:
• Maintain knowledge of all existing and new Evidence of Coverage for lines of business.
• Ability to professionally work with members, providers, agents and designated parties with regard to verification of benefits, claim and membership inquiries. This includes being responsible for investigating discrepancies and solving any issues that may occur.
• Ability to establish rapport with a broad spectrum of customers, maintaining proper voice tone and language in accordance with caller's level of understanding, and to ensure proper customer perception.
• Responsible for complete and accurate documentation of all inquiries received ensuring accurate and timely responses are provided according to departmental guidelines.
• Ability to work well within the department and with other departments to determine how to resolve a call in the best interest of the member
• Investigate and respond to member inquiries appropriately and timely. If member satisfaction is not achieved and the member chooses to file a grievance/appeal the representative is responsible for completing the appropriate paperwork, document all files, and forward the request to the appropriate personnel for resolution.
• Medicare Concierge must maintain knowledge of ESI, Care Management and member software used, to be able to complete the request from the caller.
• Confidentiality a must as you will be working with member financial and medical information.
• Assists walk in members to resolve inquiries appropriately.
3 Shifts available
8:00am - 4:30pm
9:00am - 6:00pm
11:30am - 8:00pm
• Knowledge of medical terminology preferred.
• Excellent organizational and prioritization skills.
• Effective verbal and written communication and interpersonal skills, ability to perform multiple tasks
• Strong critical thinking and problem-solving skills.
• Associate Degree preferred.
• Two or more years of customer service experience within the health insurance industry preferred.
• Experience working in a call center preferred.
• Experience working with Medicare products and population preferred.
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