Senior Call Center Representative - The Health Plan

We are searching for a Senior Call Center Representative— someone who works well in a fast-paced setting. In this position, you will serve as a member and/or provider advocate that understands the organization's processes, policies, and procedures to investigate, resolve and/or facilitate the resolution of simple to complex issues/questions. You will be the first point of contact for assistance or information regarding eligibility, benefits, authorizations, claims, referrals and/or any other member/provider demands. Lastly, you will assist and advocate for members and/or providers throughout the complaint and appeal process and support members with timely appointment scheduling.

Think you’ve got what it takes?

Job Duties & Responsibilities
•    Act as a secondary resource to Call Center Representatives in the absence of the Team Lead and responds to escalated calls and triages to management, if necessary 
•    Identify and handle a variety of routine to complex customer or prospect inquiries or requests
•    Educate members about their health coverage benefits and services and empowering members/providers by directing them toward available resources for self-help
•    Meet Senior Member Service Representative performance goals for customer satisfaction, quality, productivity, and all performance metrics
•    Ensure all HIPAA and state privacy and confidentiality requirements/regulations are adhered to at all times
•    File complaints and appeals on behalf of members and providers within the regulatory timeframe and in compliance with departmental policies and procedures

Skills & Requirements
•    High school diploma or GED
•    Minimum of 3 years of customer service, call center, and/or experience within managed care or insurance industry or
•    A Bachelor's degree may substitute for two (2) years of the required experience
 

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