Customer Service Representative

This is a fully remote position, open to applicants in Pennsylvania.

📋 Description

• Deliver prompt, courteous, and professional assistance to members, providers, group administrators, brokers, Plan staff, and the general public.

• Handle inquiries through telephone, fax, written correspondence, email, internet messenger, and face-to-face meetings.

• Investigate and analyze customer inquiries.

• Review and interpret relevant policies and procedures to determine suitable actions.

• Retrieve benefits, enrollment, and claims information using computer systems, manuals, and imaging tools.

• Address routine and moderately complex inquiries related to benefits, claims, billing, enrollment, legal requests, Medicare Secondary Payer, COBRA, reinstatements, conversions, refunds, and similar issues.

• Provide clear guidance to appropriate Plan areas for resolving issues.

• Liaise with internal and external entities to gather information and initiate necessary actions.

• Respond to customers verbally or in writing with precise and timely information.

• Monitor inquiries to ensure timely and accurate resolution and customer satisfaction.

• Update Facets or Inquiry Control System records and track the status of inquiries.

• Report trends in inquiries and processing concerns to management.

• Assist Marketing personnel and brokers by researching and conveying customer information.

• Engage in marketing initiatives such as health fairs, seminars, open enrollment, and on-site visits.

⛳️ Requirements

• High school diploma or G.E.D.

• At least 1 year of customer service experience.

• Ability to comprehend and interpret detailed policies and procedures and apply them in various scenarios.

• Strong understanding of the privacy of Protected Health Information as mandated by HIPAA.

• Capacity to work independently and adapt to evolving job assignments and work environments.

• Excellent verbal and written communication skills in a professional context.

• Strong analytical, organizational, and problem-solving abilities.

• Proficiency in using telephone systems such as Interactive Voice Response and Automated Call Distribution.

• Familiarity with personal computers and the Microsoft Office Suite.

• Capability to perform sedentary work involving sitting, talking, listening, typing, repetitive motions, and close visual inspection of documents and computer screens.

🏝️ Benefits

• Medical coverage.

• Dental coverage.

• Vision coverage.

• Retirement Plan.

• Paid Time Off.

• Holidays.

• Volunteer time off.

• Incentive Plan.

• Tuition Reimbursement.

• Flexible work environment.

• Training and continuing education.

• Opportunities for community volunteering.