Customer Services Representative required at Care Source

Company Name	Care Source
Industry	Medicine
Job Functional Area	Customer Services
Job Title	Customer Services Representative 1
Job position	1
Job Type	Full time/ Permanent
Job Location	US
Minimum Education	High school diploma or equivalent
Minimum Experience	Two years customer service experience is preferred  Customer Service experience in a call centre is preferred

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Job Description

·         Customer Service Representative I will assist Medicaid and Medicare members/providers with benefit, claims, and other inquiries.

·         The CSR I provides quality service by immediately responding to the member and/or providers requests and complaints, and appropriately routing issues to the correct department for timely resolution.

·         CSR’s are also required to capture member grievance, and relay appeals instructions for the appropriate line of business, including future lines of business.

Essential Functions are:

·         Assist members with routine servicing inquires including but not limited to; selecting a primary care physician, member benefit education, member identification cards, transportation arrangements, issues with provider accessibility, eligibility inquires, resolving member complaints, identifying and filing member grievances.

·         Assist a provider with routine servicing inquires including but not limited to; verifying eligibility, explanation of benefits, claims and appeal procedures.

·         Ensuring all HIPAA and State requirements/regulations are adhered too at all times, in existing and future lines of business.

·          Research, follow up, and resolve all open/pending issues in a timely manner to ensure member satisfaction.

·         Build and strengthen member relationships by providing quality customer service.

·         Maintain knowledge and understanding of all processes and procedures.

·         Adhere to all departmental and company policies and procedures.

·         Maintain complete and accurate documentation of all of telephone and written communications.

·         Act as a mentor to new hire employees.

·         Screen members to determine Case Management needs, and refer when appropriate.

·         Appropriately route calls to support departments including Pharmacy, and Triage, for proper/expedited resolution.

·         Assist with non-phone work such as incoming faxes and web inquires.

Desired Skills 

·         Computer proficiency with knowledge and experience in a “Windows” environment.

·         Typing, 35 WPM Experience

·         HMO or related industry experience

·         Strong written and communication skills

·         Professional phone etiquette

·         Proper use of grammar

·         Ability to work in a fast paced environment

·         Adaptable to a constantly changing environment

·         Attention to detail

·         Ability to multi task

·         Ability to work independently and with a team

·         Critical thinking and listening skills

·         Decision making and problem solving skills

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