Customer Service Representative

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

📋 Description

• Deliver exceptional customer service pertaining to Veteran care via the Community Care Network (CCN) in a dynamic contact center environment.

• Handle incoming calls and chat inquiries regarding authorizations for medical and behavioral health services, provider status and availability, and claims payment and status.

• Evaluate caller requests, address inquiries, process requests, and adhere to first-call-resolution or escalation protocols.

• Make outbound calls to arrange appointments as per Veteran or VA requests.

• Resolve administrative eligibility issues through thorough account research and review.

• Manage multiple task lists according to assigned timelines.

• Achieve standards for call volume, chat volume, schedule adherence, quality, Veteran appointments, and other production metrics.

• Initiate and receive phone calls, chat messages, and emails from VA medical center staff and providers to respond to claims, eligibility, benefit, and program inquiries.

• Assist in scheduling Veteran appointments by reaching out to providers in selected markets.

• Document preferences and track Veteran inquiries in TriWest CRM systems, the Portal, and VA HSRM systems.

• Address VA and provider inquiries with an emphasis on first-call resolution.

• Safeguard patient health information and adhere to HIPAA regulations.

• Record all communications involving Veterans and provider contacts.

• Employ critical thinking and established processes to ensure quality program compliance.

• Engage in cross-training, employee development, and flexible assignments to align with business needs.

⛳️ Requirements

• High School diploma or GED.

• Minimum of one year of experience in a customer service role with measurable performance metrics.

• Familiarity with Microsoft Office products and the Internet.

• Willingness to cover any work shift.

• Availability to work overtime, if necessary.

• Strong data entry skills.

• Capability to operate in a multi-system Microsoft environment utilizing Word, Outlook, TriWest Intranet, the Internet, and departmental software applications.

• Ability to meet daily call and chat quotas.

• Consistent and regular attendance.

🏝️ Benefits

• Comprehensive health benefits.

• Opportunities for professional development and advancement.

• Flexible work schedules.

• Supportive team environment.