Customer Service Representative (Remote, 9/11 Start Date)

Customer Service Representative (CSR) is responsible for providing an enhanced customer experience for Medica/Dean Health Plan members, providers, and group representatives. An excellent CSR will have general knowledge of the variety of Medica/Dean Health Plan products, benefits and provider networks in order to explain the effective use of benefit plans and benefits available to members and providers and determine DHP’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:

• Provide complete and accurate information about Dean Health Plan’s ongoing and changing plans and benefits in response to caller questions and concerns.
• 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.
• 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.
• Instruct members how to receive maximum benefit reimbursement, including the advantages of utilizing their primary care physician and network providers.
• Access and research various information databases to obtain knowledge to provide complete and accurate answers and make appropriate decisions about the caller’s situation.
• 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.
• Stay abreast of related regulatory, compliance, and departmental updates to meet departmental metric requirements.

Qualifications

Required:

• High level attention to detail and customer service, with the ability to handle sensitive and confidential information.
• Two years of inbound call center or related customer service experience
• High school diploma or equivalent.
• Proficient in Microsoft Office applications, with the ability to easily toggle between systems and navigate through the Internet.
• Ability to type 40-45 wpm.
• Ability to work well in a team based environment.
• Successful completion of the DHP Customer Service Training program.
• Strong verbal and written communication skills.
• Ability to handle multiple tasks simultaneously, meet time-sensitive deadlines, and organize workloads with general supervision.
• General knowledge of insurance terminology, diagnostic and procedure codes.

Preferred:

• Background in the health insurance industry, working in a clinic or billing office.

This position is a Remote role. The employee must be located in any state in which Medica is an employer and will work remotely 100% of the time.

Medica's commitment to diversity, equity and inclusion (DEI) includes unifying our workforce through learning and development, recruitment and retention. We consistently communicate the importance of DEI, celebrate achievements, and seek out community partnerships and diverse suppliers that are representative of everyone in our community. We are developing sustainable programs and investing time, talent and resources to ensure that we are living our values. We are an Equal Opportunity/Affirmative Action employer, where all qualified candidates receive consideration for employment indiscriminate of race, religion, ethnicity, national origin, citizenship, gender, gender identity, sexual orientation, age, veteran status, disability, genetic information, or any other protected characteristic.