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About the Role

The Customer Service Representative resolves customer inquiries via telephone, fax, off-phone work, and email concerning account benefits, claim payments, and enrollment. This role requires participation in training to become proficient in one line of business and potentially a second line of business within 12 months to cross-functionally support the department.

Responsibilities

• Researches, documents, interprets, and responds to inquiries from internal and external customers, business partners, and special groups concerning products, services, and policies.
• Researches and responds to questions related to claims, onboarding, effectuation, retention, and provider inquiries.
• Identifies and follows through on issues impacting the Health Plan and customer experience.
• Provides service to customers and business partners in a professional, efficient, and timely manner.
• Utilizes appropriate resources to resolve customer inquiries accurately and efficiently.
• Develops effective internal working relationships for improved communication and collaboration.
• Shares ideas and solutions to improve processes, procedures, and systems.
• Participates in meetings, training, and skill development.
• Maintains high standards of integrity and supports the company’s mission and values.
• Maintains high regard for member privacy.
• Provides expertise, daily support, mentoring, coaching, and guidance to other advocates (Level II).
• Assists with job shadowing and new employee training for multiple lines of business (Level II).

Requirements

• High School diploma or equivalent.
• Customer service experience preferred.
• Strong communication skills across multiple channels including voicemail, email, and outbound calls.
• Adept at communicating effectively and diplomatically while working as a collaborative team member.
• Strong organizational skills and ability to prioritize.
• Ability to work in a fast-paced environment and remain professional under pressure.
• Ability to efficiently resolve customer concerns by actively listening, navigating screens, typing documentation, and speaking simultaneously.
• Excellent computer skills, including navigation in a Windows environment and working between multiple programs.
• Proven reasoning and problem-solving skills.
• Ability to work occasional overtime as required.
• Performance rating of “Performing” or above in Level I for a consecutive 12-month period (Level II).
• Consistently proficient in all ancillary products (Level II).
• Ability to support specialized Groups to provide custom rules and regulations (Level II).
• Proven ability to efficiently resolve complex and escalated issues with minimal direction (Level II).
• Advanced system and navigational skills (Level II).
• Demonstrated global thinking and initiative to recognize opportunities within the team (Level II).
• Ability to work while sitting and/or standing at a workstation viewing a computer and using a keyboard, mouse and/or phone for three or more hours at a time.
• Ability to hear, understand, and speak clearly while using a phone.
• Ability to arrive at work on time and as scheduled.
• Ability to meet minimum performance metrics.

Skills

• Communication skills
• Organizational skills
• Computer skills
• Problem-solving skills
• Active listening

Location

• Remote work may be available on a case-by-case basis

Work Type

• Full-time

Experience Level

• Entry Level
• Intermediate

Education Level

• High School diploma or equivalent

Salary/Compensations

• $20/hr - $24.43/hr

Benefits

• Participation in group health and/or dental insurance
• Retirement plan
• Wellness program
• Paid time away from work
• Paid holidays

About the Company

• The Lifetime Healthcare Companies

Equal Opportunity

• All qualified applicants will receive consideration for employment without regard to race, color, religion, sex, sexual orientation, gender identity, national origin, disability, or status as a protected veteran.