Customer Service Rep PH

Spectrum Health; Grand Rapids (MI); On-site; USD 38,000 - 55,000; Full time

Job summary

Corewell Health – Priority Health is seeking a dedicated Customer Service Associate to assist members, providers, and employer groups with accessing benefits, resolving complex inquiries, and understanding claims, billing, and coding. You will respond to inquiries via phone, in person, chat, email, and other channels, educate on eligibility and coverage, and escalate issues per guidelines.

The role emphasizes accuracy, timely follow-up, and collaboration with internal teams to improve member

Qualifications

• Requires high school diploma or equivalent plus 2 years of customer-facing service experience.
• Experience in phone or face-to-face support in benefits/healthcare is preferred.
• Knowledge of billing, claims, eligibility and provider contracting is desirable.

Responsibilities

• Respond to complex service inquiries from members, providers and groups.
• Educate customers on benefits, eligibility, billing, and claim status.
• Escalate issues when needed and collaborate with internal resources.
• Place outbound welcome calls and assist walk-in members.
• Document interactions in the appropriate systems.
• Suggest process improvements based on trends or issues.

Skills

Customer service

Call center

Medical billing

Insurance benefits

Claims processing

Education

High School Diploma or equivalent

Associate's degree

Job description

Job Summary

Assist and educate members, employer groups, providers, colleagues, and/or elite agents of health plan benefits with accessing services, facilitating and resolving complex problems, understanding claims, billing and coding, along with other non-routine questions. Consistently create an exceptional experience with each contact, via inbound and outbound calls, face-to-face interactions, online chat, email, etc.

Essential Functions

Demonstrates high competency in analyzing, evaluating, and responding to complex service inquiries from members, providers, employer groups, colleagues, agents, Elite agents, and different customer types across multiple Priority Health products within departmental guidelines. Professional and pleasant interactions are ongoing expectations. Partnering with internal and external resources, promptly provides customers with information and education concerning benefit clarification, eligibility requirements, verification, authorization, billing and claim status. Promptly identifies and resolves or escalates customer concerns or complaints to achieve positive outcomes. Places outbound welcome calls to members to educate them on their benefits as needed. Assists walk-in members and agents if assigned by leadership. Adheres to established procedure and quality guidelines in support of Priority Health service promise, key drivers, performance indicators, as well as Corporate values and codes of excellence. Identifies potential trends or issues that impact health plan members and works with coworkers and leadership resources to suggest process improvements. Assists customers with administrative issues, such as submitting enrollment record changes, providing letter explaining coverage or benefits, and obtaining and relaying certain member information to other departments as needed. Facilitates claims resolution through follow-up on member calls and correspondence received to appropriate departments. Effectively tracks and/or documents all service interactions with customers within appropriate systems according to guidelines. Develops and maintains behaviors of productivity, availability to customers, and adherence to work schedule.

Qualifications

Required: High School Diploma or equivalent 2 years of relevant experience customer-facing service on phone or face-to-face; customer service, high volume call center, medical billing, insurance environment relevant to benefits, provider contracting, claims processing, and/or managed health care.

Preferred

Associate's Degree.

About Corewell Health

As a team member at Corewell Health, you will play an essential role in delivering personalized health care to our patients, members and our communities. We are committed to cultivating and investing in YOU. Our top-notch teams are comprised of collaborators, leaders and innovators that continue to build on one shared mission statement - to improve health, instill humanity and inspire hope. Join a nationally recognized health system with an ambitious vision of continued advancement and excellence.

How Corewell Health cares for you

Comprehensive benefits package to meet your financial, health, and work/life balance goals. Learn more here. On-demand pay program powered by Payactiv. Discounts directory with deals on the things that matter to you, like restaurants, phone plans, spas, and more! Optional identity theft protection, home and auto insurance. Traditional and Roth retirement options with service contribution and match savings. Eligibility for benefits is determined by employment type and status.

Primary Location

SITE - Priority Health - 1231 E Beltline Ave NE - Grand Rapids

Department Name

Provider Call Center - PH Managed Benefits

Employment Type

Full time Shift Day (United States of America) Weekly Scheduled Hours 40 Hours of Work 8:30 p.m. to 5 p.m. Days Worked Monday to Friday Weekend Frequency N/A

Corewell Health is committed to providing a safe environment for our team members, patients, visitors, and community. We require a drug-free workplace and require team members to comply with the MMR, Varicella, Tdap, and Influenza vaccine requirement if in an on-site or hybrid workplace category. We are committed to supporting prospective team members who require reasonable accommodations to participate in the job application process, to perform the essential functions of a job, or to enjoy equal benefits and privileges of employment due to a disability, pregnancy, or sincerely held religious belief. Corewell Health grants equal employment opportunity to all qualified persons without regard to race, color, national origin, sex, disability, age, religion, genetic information, marital status, height, weight, gender, pregnancy, sexual orientation, gender identity or expression, veteran status, or any other legally protected category. An interconnected, collaborative culture where all are encouraged to bring their whole selves to work, is vital to the health of our organization. As a health system, we advocate for equity as we care for our patients, our communities, and each other. From workshops that develop cultural intelligence, to our inclusion resource groups for people to find community and empowerment at work, we are dedicated to ongoing resources that advance our values of diversity, equity, and inclusion in all that we do. We invite those that share in our commitment to join our team. People are at the heart of everything we do, and the inspiration for our legacy of outstanding outcomes, innovation, strong community partnerships, philanthropy and transparency. Corewell Health is a not-for-profit health system that provides health care and coverage with an exceptional team of 60,000+ dedicated people—including more than 11,500 physicians and advanced practice providers and more than 15,000 nurses providing care and services in 22 hospitals, 300+ outpatient locations and several post-acute facilities—and Priority Health, a provider-sponsored health plan serving more than 1.2 million members. Through experience and collaboration, we are reimagining a better, more equitable model of health and wellness.