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Customer Service Rep (Remote)

Company

Medica

Address United States
Employment type FULL_TIME
Salary
Category Insurance
Expires 2023-06-21
Posted at 10 months ago
Job Description
Customer Service Representative (CSR) is responsible for providing an enhanced customer experience for Medica members, providers, and group representatives. An excellent CSR will have general knowledge of the variety of Medica products, benefits and provider networks in order to explain the effective use of benefit plans and benefits available to members and providers and determine Medica's liabilities and obligations in various medical circumstances. CSR is expected to utilize excellent communication and problem-solving skills in order to resolve complex inquiries from internal and external customers. CSR must be customer-focused and motivated to implement ideal quality concepts with all callers including those who may be emotionally escalated. CSR will have the ability to work in a fast-paced, dynamic and technologically-based environment while having the ability to learn and implement new processes quickly. CSR will provide dependable and accurate results on a routine basis with close supervision and/or technical assistance. CSR must ensure compliance with department and regulatory requirements.
Training: 6-8 of paid remote training (8:00-4:30pm CST M-F)
Work Hours: Varying shifts between 7:30am- 5:15pm Monday through Thursday, and Fridays 8am-4:30pm CST
Essential Job Duties:
  • Accurately and completely document each phone call in accordance with the department’s standards, monitor the types of inquires received, and report trends and concerns to the Management Team.
  • Instruct members how to receive maximum benefit reimbursement, including the advantages of utilizing their primary care physician and network providers.
  • Educate and inform members about the benefits available under and the requirements of Dean Health’s benefit plans and provide assistance by initiating and coordinating the exchange of information among members, providers, and other internal departments involved in the relevant processes over the telephone.
  • Determine the various policy provisions, guidelines, providers, and provider requirements and procedures; medical review procedures; and the procedures of other Dean Health Plan departments that apply to the need or concern of the member.
  • Stay abreast of related regulatory, compliance, and departmental updates to meet departmental metric requirements.
  • Provide complete and accurate information about Dean Health Plan’s ongoing and changing plans and benefits in response to caller questions and concerns.
  • Access and research various information databases to obtain knowledge to provide complete and accurate answers and make appropriate decisions about the caller’s situation.
Qualifications
Required:
  • High level attention to detail and customer service, with the ability to handle sensitive and confidential information.
  • Successful completion of the Medica Customer Service Training program.
  • Two years of inbound call center or related customer service experience
  • Ability to work well in a team based environment.
  • Ability to handle multiple tasks simultaneously, meet time-sensitive deadlines, and organize workloads with general supervision.
  • Proficient in Microsoft Office applications, with the ability to easily toggle between systems and navigate through the Internet.
  • General knowledge of insurance terminology, diagnostic and procedure codes.
  • Strong verbal and written communication skills.
  • High school diploma or equivalent.
Preferred:
  • Background in the health insurance industry, working in a clinic or billing office.