Customer Service Associate I

Customer Service Associate I Responsible for answering calls clearly and concisely, responding to questions, and providing guidance on transactions, inquiries, or complaints from both internal and external customers. Documents and resolves inquiries by using established best practices and educates members about available products and services, while adhering to compliance requirements and Centers for Medicare and Medicaid Services (CMS) standards.

• Makes outbound calls to members, providers, pharmacies, and/or hospitals etc. to resolve issues as needed.
• Interacts with other departments including Enrollment and Medical Management to resolve issues.
• Handles escalated situations and acts urgently when necessary
• Adheres to compliance requirements and CMS standards.
• Responds to customer calls accurately and professionally including correct grammar and a friendly tone while also demonstrating a genuine delight to serve.
• Resolves customer service inquiries for 1-2 communities which could include benefit and eligibility information, billing and payment issues, customer material requests, physician assignments, authorization for treatment, and Explanation of Benefits (EOB).
• Provides first call resolution for all customers.
• Investigates and responds to general inquiries while documenting in the system as appropriate.

• Familiarity with computer, Windows PC applications, and the ability to learn new and complex computer system applications
• Ability to read, comprehend, and accurately follow instructions in a constantly changing environment
• Solid verbal communication skills including the ability to speak to associates and customers at all levels
• Ability to work flexible hours throughout the year; the call center is open from 7am - 10pm CT. Following training, you must be able to work the later shift which could end as late as 10pm CT. The call center is also open on weekends during the busy season.
• Strong commitment to Service Excellence and delivering a customer service experience that results in a Five Star CMS rating
• Ability to be detail oriented and organized
• Strong investigative and problem-solving skills
• Working knowledge of Microsoft Outlook, Word, Excel, and PowerPoint
• High School diploma, GED, or equivalent

• Prior health care or insurance experience
• 6+ months of related experience
• Bi-lingual

• While performing the duties of this job, the employee works in normal office working conditions.

• The job description describes the general nature and level of work being performed by people assigned to this job and is not intended to be an exhaustive list of all responsibilities, duties and skills required. The physical activities, demands and working conditions represent those an employee encounters while performing the essential functions of this job. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential job duties and responsibilities.

$15.05-$18.01 Alabama, Alabama, Arizona, Arkansas, Colorado, Connecticut, Delaware, Florida, Georgia, Idaho, Illinois, Indiana, Iowa, Kansas, Kentucky, Louisiana, Maine, Maryland, Massachusetts, Michigan, Minnesota, Mississippi, Missouri, Montana, Nebraska {+ 21 more} Full time