Customer Service Representative

JOB SUMMARY:

Provides outstanding customer service related to Veteran care through the Community Care Network (CCN) in a fast-paced contact center. Responds to inbound calls and chat messages regarding authorizations for medical and behavioral health care, provider status and availability, or claims payment and status. Accurately assesses caller requests, answers caller inquiries and processes requests while focusing on first call resolution and/or appropriate call escalation protocols. May make outbound calls to schedule appointments based on Veteran or VA request. Resolves administrative eligibility discrepancies through account research and review.

EDUCATION & EXPERIENCE

Required

• High School diploma or GED
• One year of experience in a customer service role with performance metrics
• Experience using Microsoft Office products and the Internet

Preferred

• Healthcare industry experience to include knowledge of health services and claims
• Contact center experience to include call center chat messaging
• Military experience focusing on service delivery

KEY RESPONSIBILITIES

• Manages multiple tasks lists in accordance with directed timelines. Meets call volume, chat volume, schedule adherence, quality, Veteran appointment, and other production standards.
• Initiates and receives phone calls, chat messages and emails from VA medical center staff, and providers to answer claims, eligibility, benefit, and program questions. In select markets, facilitates appointment scheduling of Veterans through outbound solicitation to providers. Records preferences tracks Veteran questions thoroughly in the TriWest’s Customer Relationship Management systems and Portal, as well as VA’s HSRM systems.
• Consistently displays professional and courteous service skills to internal and external customers.
• Accurately resolves VA and provider inquiries with a focus on first call resolution.
• Protects the privacy of health information of patients when using or disclosing Protected Health Information (PHI).
• Takes appropriate measures to comply with HIPAA regulations to protect privacy of customers' health information.
• Documents all communications involving Veteran and provider contacts. Uses critical thinking in problem solving and follows established processes to assure quality program compliance.
• Consistently meets department productivity and performance metrics to include regular and consistent attendance.
• Participates in cross training, employee development and flexible assignments to ensure business needs are met.

COMPETENCIES

Technical Skills

Proficient data entry skills: Ability to meet daily call and chat requirements.

Team Building / Team Player

Influence the actions and opinions of others in a positive direction and build group commitment.

Organizational Skills

Ability to organize people or tasks, adjust to priorities, learn systems, within time constraints and with available resources; Detail-oriented.

Information Management

Ability to manage large amounts of complex information easily, communicate clearly, and draw sound conclusions.

High Intensity Environment

Ability to function in a fast-paced environment with multiple activities occurring simultaneously while maintaining focus and control of workflow.

Empathy / Customer Service

Customer-focused behavior; Helping approach, including listening skills, patience, respect, and empathy for another's position.

Coping / Flexibility

Resiliency in adapting to a variety of situations and individuals while maintaining a sense of purpose and mature problem-solving approach is required.

Computer Literacy

Ability to function in a multi-system Microsoft environment using Word, Outlook, TriWest Intranet, the Internet, and department software applications.

Communication / People Skills

Ability to influence or persuade others under positive or negative circumstances; Adapt to different styles; Listen critically; Collaborate.

Commitment to Task

Ability to conform to established policies and procedures; exhibit high motivation.

WORKING CONDITIONS

• Ability to cover any work shift
• Ability to work overtime, if needed
• Works in a remote environment, with no travel
• Extensive computers work with prolonged sitting and wearing of headset

Revelations is committed to providing equal employment opportunity to all employees and applicants. Employment decisions are made without regard to race, color, religion, creed, sex (including pregnancy, sexual orientation, gender identity or expression), national origin, age, disability, genetic information, marital status, veteran status, or any other characteristic protected by federal, state, or local law. This policy applies to all aspects of employment, including recruitment, hiring, compensation, promotion, training, discipline, and termination.

This job description indicates the general nature and levels of work expected of the incumbents. It is not designed to cover or contain a comprehensive listing of activities, duties, responsibilities, or competencies required of an incumbent. Incumbents may be asked to perform other duties as required.