Customer Service Representative I (4300) at The Word & Brown Companies in Orange, CA 92868

Job description

• Salary Range
• The Customer Service Rep I handles calls from customers to resolve, educate, follow-up and respond to questions regarding ChoiceBuilder plan administration and procedures for groups, members, brokers and general agencies.

Responsibilities

• Understanding of company policies and procedures as they apply to ChoiceBuilder plans.
• Answers questions via telephone or email from groups regarding new hires, billing, rates, supplies, administrative procedures, etc.
• Educates, via telephone or email, employees/dependents regarding ID cards, administrative procedures, dependent coverage, address changes, etc.
• Follows-up on calls and emails from brokers regarding problems that their groups are experiencing with providers.
• Ability to interact with brokers, general agents and sales representatives on a daily basis and must be able to answer questions regarding ChoiceBuilder processes.
• Responds to calls from providers to confirm eligibility and benefits.
• Verifies enrollments and resolves issues with carriers.
• Expedites processing of members enrollment with carrier if urgent services are needed.
• Review and submit appeal requests from groups.
• Review /Audit group billing and explain to clients in clear and accurate manner.
• Document calls in call tracking system.
• Ability to work in a paperless environment with the Doc Link system.
• Departmental standard requires each Customer Service Representative to provide Service of Unequalled Excellence to all callers by maintaining an average of 90% or greater on Call Reviews.
• Answer at least 100% of the daily call volume average.
• Provide clear and explicit documentation while maintaining percentage at a level of 90% or higher daily in applicable databases (i.e. Doc Link and Opportunity)
• Make busy time of 20 minutes or less per day.
• Meet department standards for quality and quantity of work.
• Meet department and team standards for turnaround times.
• Adhere to all HIPAA (Health Insurance Portability and Accountability Act) and PHI (Personal Health Information) guidelines.
• On-site or remote regular attendance and punctuality are essential functions of the job.
• Performs other business tasks or functions as assigned.

Requirements

• CA Life & Health license required. If successful applicant does not have insurance license, it is required to obtain one within six (6) months of date of hire.
• Must have excellent verbal and written communication skills, especially under pressure.
• Ability to handle irate customers in a courteous, patient, calm and positive manner while maintaining a high quality and quantity of work.
• Experience in handling high call volume.
• Must be computer literate in Microsoft Word, Excel, and Outlook.
• Accurate data entry skills a must. Computer literate (Windows) and Word Processing Skills (MSWord). Typing at 55 WPM or more.
• Knowledge of the health insurance industry and at least two (2) years customer service experience preferred.
• Must be able to work in a fast-paced environment where deadlines are a priority and handling multiple assignments simultaneously.
• Problem Solving Skills required.
• Must have a proficient knowledge of the English language.
• Proficient knowledge of the Spanish language is a plus. If hired as a Bilingual representative, Language Assistance Certification is required every two (2) years.
• High school diploma or equivalent required.
• Action Oriented, Approachability, Customer Focus, Humor, Listening, Patience, Self-Knowledge, Technical Learning, Time Management, Written Communication

Skills

Required

• Experience in handling high call volume.
• Problem Solving Skills required.

Benefits

• Position Type