Health Care Call Center Customer Service Representative

Role Insights

This role of Customer Service Professional is considered an essential position within the organization. The Call Center is the communication hub between our clients, patients, and internal departments. You will be required to accept incoming calls at a very rapid pace, problem solve any challenges presented with claims, authorizations for service, and various other issues. This is not a routine position as it requires energy, enthusiasm, and the desire to give 5 star quality service.

The right candidate should have confidence in their abilities as a problem solver, and have the poise to execute solutions in a timely fashion. You will also be responsible for making follow-up calls to resolve challenges throughout your day. Good time-management is essential.

Some of your Key Performance Indicators (KPI) will include the amount of inbound and outbound calls made/received per day, how many calls you will have needed to escalate to a manager versus concluding them on your own, and other various KPI’s.

Primary Responsibilities

· Receive inbound calls from Health Providers, Health Plans, and patients requesting status updates and information on Claims, Authorizations for Service, Eligibility for Service, and various other related Medical questions

· Provide information on eligibility for medical services

· Transfer calls to appropriate departments when applicable

· Identify, research, and resolve any issues regarding Claims, Eligibility, Authorizations for Service, ETC.

· Make outbound calls for follow up purposes when needed

· Recognize and alert management of inappropriate trends in customer calls

· Recommend process improvements

· Document all calls and actions in AMM proprietary software

· Other duties as assigned

Required Skills and Abilities

· Fluency is another language is preferred but not required. (Korean, Vietnamese, Spanish, etc.)

· High School Diploma, GED required. Associates degree preferred

· 2+ years of call center experience is strongly preferred

· 1+ year in medical or healthcare environment preferred

· High energy and goal orientated

· Problem solving and time management skills

· Brilliant verbal and written skills

· Proficient in Word, Outlook, Excel

· Positive attitude with great interpersonal skills

· Outstanding work ethic

· World-class customer service skills

· Ability to work Monday through Friday 8:00am – 5:00pm