Customer Services Specialist

SGS Consulting
Michigan

Job Responsibilities:

  • Respond to inquiries by telephone, mail and in person; research and answer inquiries, complaints and appeals by following all department standards, policies and procedures; direct inquiries to supporting departments for appropriate action and resolution.
  • Educate existing and potential members on policies, procedures, product offerings, benefit plan and coverage provisions related to all HAP products.
  • Document all incoming inquiries accurately in to track member inquiry history and trends.
  • Practice and maintain confidentiality to Privacy and HIPAA regulations.
  • Proactively seek training and development to enhance skills and abilities.
  • Monitor workflow inbox and outstanding cases to ensure that all inquiries receive an appropriate response in a timely manner; contact members (by phone/or in writing), as needed, to ensure timely resolution and follow-up to inquiry.
  • Interact with support departments in a professional manner to ensure member needs are met.
  • Develop and maintain strong business relationships with inter-departments; continue to self-educate on changes in policies and procedures that occur in other departments which could have an impact on department operations and the servicing of member/customers.
  • Attend training and development sessions or continuing education opportunities offered by Customer Service and maintain enhanced skill levels and performance.
  • Interact with providers and their staff to obtain information for resolving customer inquiries and complaints.
  • Ensure and maintain compliance of all department and corporate standards, policies and procedures.
  • Recommend process improvements based on observations and trends identified while interacting with internal and external customers.
  • Coordinate and assist with various departmental projects, member enrollment periods, outreach activities and corporate initiatives.
  • Perform other related duties as assigned.

Skills:

  • Minimum of two (2) years of recent Customer Service or Call Center experience within the last three years.
  • Must be dependable.
  • Demonstrate a high degree of integrity, patience, maturity, empathy, tact and Diplomacy.
  • Demonstrate problem solving skills, flexibility, good judgment and ability to provide service excellence.
  • Demonstrate efficiency in using a PC and various Microsoft programs.
  • Fundamental understanding of HMO/PPO/POS delivery system and claims billing.
  • Must be able to work flexible shifts, overtime including evenings and weekends as requested and/or scheduled.

Education/Experience:

  • Course in Medical Terminology (required completion within six months post-employment).
  • Associate’s Degree
  • A minimum of four (4) years of recent and related work experience in a customer service capacity may be considered in lieu of the degree.
Posted 2025-12-11

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