Job Requirements
POSITION SUMMARY
The Customer Care Representative applies knowledge and sound communication skills to investigate and independently resolve telephone and in-person inquiries from customers and providers regarding health benefits, claims, authorizations, prescriptions, providers, eligibility, enrollment, and any other plan-related questions. The Customer Care Representative will make each interaction effortless by creating forward-moving, solution-oriented conversations and providing complete and accurate solutions for an easy, enjoyable, and seamless customer experience.
PRIMARY ACCOUNTABILITIES
- Builds customer loyalty and trust by being a solution-minded advocate who educates, empowers, and supports our customers throughout their Health First wellness journey.
- Guides customers through their inquiries to successful resolution by actively listening, creating two-way conversations, and utilizing critical thinking.
- Recognizes the customer’s initial inquiry and proactively identifies any underlying or unspoken needs by asking probing questions to guide the customer through any complex issues.
- Offers each customer a personalized solution and time frame to meet their needs. Provides alternative options, adhering to applicable department policies, when a customer’s preferred resolution is not available.
- Supports fellow associates and models excellence in service behavior for customer inquiries.
- Supports and assists with customer requests for benefit, reimbursement, or plan documents to be sent via mail, fax, and email, while exercising advanced knowledge of HIPAA guidelines.
- Assists with customer service walk-in members in a timely and efficient manner.
Work Experience
MINIMUM QUALIFICATIONS
- Education: High School/GED
- Licensure: None
- Certification: None
- Work Experience: One (1) plus years of experience as a HFHP Customer Care Associate
- Work Experience in lieu of Education: None
- Knowledge/Skills/Abilities:
- Demonstrated knowledge and understanding of prescription drug coverage concepts, eligibility, coverage, claims, and payment provisions.
- Demonstrated knowledge and understanding of processes and procedures for member appeal and grievance rights including coverage determination, and organization determinations.
- Demonstrated proficiency with core applications, including Health First Health Plans’ administrative, pharmacy, utilization management, claims, enrollment, and payment systems, Microsoft applications, and member, broker, and provider portals.
- Knowledge of Health First Health Plans’ call center and administrative operations.
- Excellent verbal, written, and interpersonal communication skills that model I-CARE values and consistently provide a seamless and delightful customer experience.
- Demonstrated consistency with achieving productivity and quality metrics.
PREFERRED QUALIFICATIONS
- Education: Bachelor’s degree in business, Health Care Administration, or related field from an accredited college or university.
- Work Experience: Coaching experience in a customer service environment.
PHYSICAL REQUIREMENTS
- Majority of time involves sitting or standing; occasional walking, bending, stooping.
- Prolonged periods of computer time or at workstation.
- Light work that may include lifting or moving objects up to 20 pounds with or without assistance.
- May be exposed to inside environments with varied temperatures, air quality, lighting and/or low to moderate noise.
- Communicating with others to exchange information.
- Visual acuity and hand-eye coordination to perform tasks.
- Workspace may vary from open to confined; on site or remote.
- May require travel to various facilities within and beyond county perimeter; may require use of personal vehicle.
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