Responds to and resolves various customer inquiries via telephone and correspondence, and resolves claims problems within established production and quality standards. Answers incoming calls and written requests for information from members or providers promptly and accurately. Composes routine and non-routine correspondence to answer member inquiries that require a written response. Coordinates with other departments to ensure timely and appropriate responses. Expedites and resolves complex issues and makes claim adjustments. Educates others on the companies’ product, providing accurate information and updates to policies and procedures, improving overall customer satisfaction in the process.
Have strong customer service experience (especially phones) and a proven ability to meet performance standards. Strong organizational skills. Ability to work independently. Ability to mentor others. Ability to interpret the various health plans and any documentation associated with them. 1-2 years of related experience successfully demonstrating increasingly higher level work required.