Senior Customer Service Representative | CareEnroll | United States

Senior Customer Service Representative

Job Description

Reports to: Customer Service Supervisor

Company: Vision Financial Services

Department: ServicePlus

Title: Senior Customer Service Representative (SCSR)

Classification: Non-Exempt

Date: October 2023

Company Values:

• Make a Difference
• Help First
• Straight Talk
• Grow or Die
• Victor, Not Victim

Position Summary:

The Senior Customer Service Representative (L2) is responsible for providing excellent customer service and support during inbound and outbound calls for Indiana Medicaid members. The representative is expected to manage a high volume of calls while maintaining accuracy. The primary roles of the positions are:

1. Assist members with inquiries related to their Medicaid coverage, benefits, and enrollment.

2. Meets individual and team performance goals.

3. Maintaining member records throughout all databases.

4. Transferring calls to the client’s call center as appropriate

Essential Functions

Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions

Assist members with inquiries related to their Medicaid coverage, benefits, and enrollment.

• Educate members on Medicaid policies and procedures, including enrollment, redetermination, plan options, and benefits.
• Providing excellent customer service by addressing customer inquiries, complaints, or concerns in a professional and courteous manner.
• Reporting grievances and escalations using the appropriate channels.

Meets individual and team performance goals.

• CSR focuses on accuracy of information provided to all callers and utilizes resources to ensure it is correct.
• CSR focuses on the quality of their calls, ensuring they understand the needs of the member, adhere to the policies and procedures, as well as meet quality metrics.
• CSR focuses on meeting the productivity metrics given, such as average wrap up time, time spent in call, and time spent on hold.

Maintaining member records throughout all databases.

• Maintain accurate and up-to-date member records and documentation of all interactions in the call center system.
• May assist with manual noting processes as needed.
• Utilizes various systems and software applications to assist members such as electronic health record systems, eligibility systems, claims, and customer relationship management (CRM) systems.
• Effectively utilizes Interpretive Language Services for non-English speaking members.

Transferring calls to the client’s call center as appropriate

• Assists with client outreach requests and follows up with supervisor on call resolution in a timely manner.
• Assists with client outreaches as necessary for payment processing, health needs screeners, and other campaigns as needed.

Other Responsibilities

• Adheres to the company’s values at all times
• Adheres to the organization’s confidentiality policy and the protection of confidential information at all times including all company policies and procedures.
• Treats clients, members, patients, guests, staff, and others with care, courtesy, and respect.

Competencies

• Working knowledge in Microsoft Office and auto dialer tools
• Demonstrates the capability to efficiently manage multiple systems and software applications simultaneously.
• Ability to accurately communicate summary information in a written format.
• Excellent interpersonal and communication skills (both verbal and written) necessary to interact with members, staff, guests, providers, and clients, to clearly articulate complex information to a diverse population of members.
• Critical thinking and listening skills.
• Independent problem identification/resolution and decision-making skills
• Conflict resolution and negotiation skills.
• Empathetic and sincere, superior rapport building skills
• Excellent verbal communication skills
• Familiarity with medical terminology to explain healthcare benefits and ensure each member’s needs are appropriately met.
• Ability to type at a minimum of 45 wpm.

Supervisory Responsibility

This position has no supervisory responsibilities.

Work Environment

This job operates in a professional office environment. This role uses standard office equipment such as computers, computer phone headsets and phones.

Physical Demands

While performing the duties of this job, the employee is regularly required to talk or hear. The employee frequently is required to sit, use hands to finger, handle or feel; and reach with hands and arms. Prolonged periods sitting at a desk and working on a computer. Must be able to lift up to 15 pounds at times.

Position Type and Expected Hours of Work

This is a full-time position. Shifts are scheduled at times when the Call Center is open Monday through Friday, 7:00 a.m. to 7 p.m. Central time. Evening and weekend work may be required as job duties demand and for team meetings.

Travel

No travel is expected for this position.

Required Education and Experience

• High school diploma or GED.

Preferred Education and Experience

• One or two years’ experience in insurance.
• Knowledge of Medicaid
• Experience with Artiva software.
• Accounts Payable experience.
• Bi-lingual

Additional Eligibility Qualifications

• Ability to handle complex accounts with little to no assistance.
• Ability to use the non-conformity to escalate issues.
• Ability to pass a knowledge assessment.

Job Type: Full-time

Benefits:

• 401(k)
• Dental insurance
• Health insurance
• On-the-job training
• Paid time off
• Vision insurance
• Work from home

Shift:

• 8 hour shift
• Day shift
• Evening shift
• Morning shift

Location:

• South Bend, IN (Required)

Work Location: Remote

Tagged as: remote, remote job, virtual, Virtual Job, virtual position, Work at Home, work from home