Customer Service Representative, Pacific/Mountain Time Zone

This is a fully remote position, open to applicants in Arizona, +5 more states.

📋 Description

• Address general customer inquiries through telephone, email, and written correspondence regarding insurance benefits, provider contracts, reimbursement programs, eligibility, and claims in a confidential, professional, and ethical manner.

• Evaluate problems and offer information or solutions.

• Investigate and resolve outstanding Customer Service calls in accordance with company standards.

• Utilize the Health Care Processing System (HCPS), imaging systems, and other necessary systems to efficiently obtain and extract information.

• Foster and maintain positive customer relations while coordinating with various company functions to ensure customer requests and inquiries are addressed appropriately and promptly.

• Take responsibility when identifying an issue or trend by assisting in assessing and reporting its impact, implementing improvements, and making necessary adjustments along the way.

• Adhere to quality guidelines to provide outstanding customer support and ensure scores meet or exceed expectations.

• Accurately document database activities and customer interactions for tracking and analysis to identify trends and resolve operational and service challenges.

• Research and analyze data to tackle standard operational challenges and customer service issues.

• Provide customers with the requested information, particularly in challenging situations involving upset customers.

• Meet or surpass all departmental and performance service metrics.

• Communicate with relevant departments and identify service issues.

• Recognize inefficiencies within established processes and propose potential solutions to save time, mitigate risk, and/or reduce costs.

• Maintain regular attendance in accordance with employee handbook guidelines.

• Leverage all capabilities to fulfill a single mission — enhancing the competitiveness and profitability of our members.

⛳️ Requirements

• High School diploma or GED and/or one (1) to three (3) years of experience in customer service within a call center environment is preferred.

• Familiarity with Health Benefits and eligibility is preferred.

• Strong communication and telephone skills with a clear and concise speaking voice.

• Proficient written communication skills with the ability to learn new software and navigate multiple systems simultaneously.

• Moderate keyboarding skills, including proficiency in database management.

• Strong organizational and time management skills.

• Adaptable in a constantly changing environment.

• Skilled in researching and resolving standard technical problems or client issues as they develop.

• Good judgment, negotiation skills, and the ability to work with minimal supervision.

• Ability to learn and understand the company's end-user software programs.

• Capability to meet or exceed departmental service metrics.

• Fluency in English (oral and written) is required.

• Bilingual in Spanish is preferred.

• Internet access provided by a cable or fiber provider with download speeds of 40 MB and upload speeds of 10 MB.

• A home router with wired Ethernet (wireless connections and hotspots are not permitted).

• A designated workspace for your office or measures taken to protect company information (e.g., positioning the computer towards a wall, etc.).

• A functioning smoke detector, fire extinguisher, and first aid kit on site.

🏝️ Benefits

• A comprehensive benefits package that includes profit-sharing.

• Flexible work arrangements, including options for working from home, in-office, or hybrid setups.