Customer Services Specialist

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:

• Required Education:
• 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 customer service capacity may be considered in lieu of the degree.