Associate

WORK FROM HOME - Customer Service Call Center Representative

Essential Duties and Responsibilities (include but are not limited to):

• Be available to handle member inquiries.
• Represent Health Plan by answering and documenting all incoming contacts to determine their nature, and respond to complex calls related to specialized product lines or questions.
• Respond with empathy to complaints and concerns from members concerning health plan benefits, account status, payment history, and medical services.
• Initiate contact with the appropriate health plan, medical group and facility personnel to obtain information relevant to the concern or inquiry as needed.
• Evaluate data to determine and implement the appropriate course of action to resolve the complaint and/or coordinate service recovery.
• Document according to procedure.
• Assist department in reaching call handling goals, first contact resolution goals, complaint resolution compliance, member retention and making return contact as warranted.
• Complete required training (including, but not limited to, annual certifications) and understand how to use tools available to recall necessary information.
• Effectively diffuse anger, tension, and hostility, within regulatory guidelines.
• Maintain awareness of the way performance and actions affect members.
• Be open and receptive to feedback and change behavior to improve performance.
• Be able to answer Healthcare Member and Provider inquiries and type information into the computer system simultaneously.

Qualifications - External

• Must have Internet to include a router with Ethernet jack for connectivity to PC (Subject to change: FS Guidelines 25 down/15 up min; BCBSM Guidelines 50 down/25 up min).
• Must have a private workstation to perform your work.
• Must have quiet area free from distractions.
• Must have childcare/Family care, as you are unable to perform job and take care of child/children or family members.
• Call center experience preferred.
• Health insurance experience.
• High School diploma or equivalent is required.
• 2 years customer service experience preferred.
• Minimum typing speed = 30-35 wpm preferred.
• Substantial understanding of the job, apply knowledge and skills to complete a wide range of tasks.
• Excellent written and verbal skills.
• Problem-solving skills.
• Basic knowledge of personal computers required.
• Strong reading comprehension and writing skills.
• Follow established procedures to meet customer needs.