Customer Care Representative

Capital District Physicians Health Plan Inc; Town of Colonie (NY); Remote; USD 60,000 - 80,000; Full time

Job summary

A community-focused health plan is seeking a Customer Care Representative to manage member education and resolve service inquiries. This remote role requires a high school diploma, customer service experience, and strong problem-solving skills. The position offers competitive salary packages and opportunities for professional growth.

Benefits

Comprehensive health care coverage

Generous paid time off

Flexible work environment

Qualifications

• Customer service experience preferred.
• Strong ability to solve problems related to benefits and claims.
• Ability to communicate effectively both verbally and in writing.

Responsibilities

• Educate members about the Plan and address service problems.
• Review eligibility requirements and provide benefit information.
• Handle multiple product lines and assist with enrollment applications.

Skills

Customer service experience

Problem-solving ability

Microsoft Word proficiency

Attention to detail

Education

High school diploma or GED

Job description

Grounded by a compelling mission, core values, and compassion for people, CDPHP and its family of companies offer a strong foundation for a rewarding career. Established in 1984, CDPHP is a physician-founded, member-focused, and community-based not-for-profit health plan that offers high-quality affordable health insurance to members throughout New York.

The Customer Care Representative shall assume full responsibility and ownership for all aspects regarding education of the member, the Employer Groups, Brokers and/or prospective members regarding the proper utilization of the Plan. In addition, the incumbent will address and resolve service problems, complaints, and advise the customer of their rights and responsibilities. The Member Service Representative will work closely with all departments, such as Marketing, Enrollment, Pharmacy (internal and external), Provider Services, and Claims Operations to resolve member inquiries as defined within Member Services Procedures.

The incumbent will also review eligibility requirements, provide rates for various health products, provide usual and customary rates based on procedural codes, and assist prospective members with enrollment applications as requested by the customer. Representatives are required to handle multiple product lines, complete system updates and respond to members via telephone and correspondence.

QUALIFICATIONS:

• High school diploma or GED required.
• Customer service experience preferred.
• Experience working in a fast-paced high volume call center preferred.
• A background in health insurance claims and appeals processing is preferred.
• Experience with a documentation system to track inquiries generated and received preferred.
• Strong working knowledge of Microsoft Word required.
• Demonstrated ability to determine, analyze and solve problems related to benefits, claims processing, claims and benefit appeals/complaints, enrollment and premium billing issues required.
• Ability to interpret all CDPHP's health plan contract language, riders, schedules.
• Demonstrated ability to effectively communicate on a verbal and written basis using appropriate grammar, spelling, punctuation, and sentence structure is required with members, providers, marketing, pharmacists, governmental agencies, and other persons associated with CDPHP.
• Strong attention to detail and capability to meet established quality and productivity standards.
• Ability to complete system updates.

Our call center is open from 8 am to 8 pm Monday - Friday. This is a remote position - great opportunity to work from home! Regional to New York State.

CDPHP salary ranges are designed to be competitive with room for professional and financial growth. Individual compensation is based on several factors unique to each candidate, such as work experience, qualifications, and skills. In addition to cash compensation, CDPHP employees may be eligible for an incentive payment, a discretionary cash reward based on employee and company performance.

CDPHP compensation packages go far beyond just salary. The company offers a comprehensive total rewards package that includes award-winning health care coverage, health care dollars, a generous paid time off allowance, employee assistance programs, flexible work environment, and much more.

As an Equal Opportunity / Affirmative Action Employer, CDPHP will not discriminate in its employment practices on the basis of race, color, creed, religion, sex (including pregnancy, childbirth, or related medical conditions), sexual orientation, gender identity or expression, transgender status, age, national origin, marital status, citizenship, disability, criminal record, genetic information, predisposition or carrier status, status with respect to receiving public assistance, domestic violence victim status, protected veterans status, or any other characteristics protected under applicable law.