Customer Service Representative I

Western Growers Health; Irvine (CA); On-site; USD 40,000 - 55,000; Full time

Job summary

Western Growers Health is seeking a Customer Service Representative for the Child Care Providers United (CCPU) program. The role involves consultative telephonic and web-based assistance to Providers, Agents, and Enrollment Specialists within Health Benefits Exchange administration, and guides individuals on eligibility management procedures and troubleshooting application issues.

Responsibilities include handling inquiries about insurance benefits, provider contracts, eligibility, and claims

Qualifications

• Foster and build good working relationships with Providers, Agents, Certified Enrollment Counselors, and federal and state agency contacts.
• Respond to customer questions telephonically or in writing regarding insurance benefits, provider contracts, eligibility, and claims confidentially, professionally, and ethically.
• Research and resolve aged customer service open calls within company standards.
• Obtain and extract information from the Health Care Processing System (HCPS) and other systems.
• Develop and maintains positive customer relations and coordinate with various departments to ensure customer requests and questions are handled appropriately and promptly.
• Be accountable and resolve issues by measuring impact, improving, and correcting course.
• Adhere to the call center’s quality assurance guidelines to ensure best-in-class service is provided during all interactions.

Responsibilities

• Thoroughly document information, activities, inquiry outcomes, and changes in the database for accurate tracking and analysis.
• Research and analyze data to address operational challenges and customer service issues.
• Provide external and internal customers with the requested information.
• Communicate with the appropriate departments and identifies service issues.
• Identify inefficiencies within the established processes and suggest possible solutions to save time, reduce risk, and reduce expenses.
• Meet and maintain all KPIs to support the department service metrics and performance objections.

Job description

Job Description Summary
Under the direction of the Senior Supervisor, Customer Service, the Child Care Providers United (CCPU) customer service representative provides consultive telephonic and web-based assistance to Child Care Providers, Agents, and Enrollment Specialists in the Health Benefits Exchange administration. In addition, the incumbent will provide customer service support to individuals by instructing them on correct eligibility management procedures and troubleshooting application issues and concerns. This position is also responsible for responding to general customer inquiries regarding insurance benefits, provider contracts, eligibility, and claims in a confidential, professional, and ethical manner.

Job Description Summary
Under the direction of the Senior Supervisor, Customer Service, the Child Care Providers United (CCPU) customer service representative provides consultive telephonic and web-based assistance to Child Care Providers, Agents, and Enrollment Specialists in the Health Benefits Exchange administration. In addition, the incumbent will provide customer service support to individuals by instructing them on correct eligibility management procedures and troubleshooting application issues and concerns. This position is also responsible for responding to general customer inquiries regarding insurance benefits, provider contracts, eligibility, and claims in a confidential, professional, and ethical manner.

Duties And Responsibilities

• Foster and build good working relationships with Providers, Agents, Certified Enrollment Counselors, and federal and state agency contacts.
• Respond to customer questions telephonically or in writing regarding insurance benefits, provider contracts, eligibility, and claims confidentially, professionally, and ethically.
• Research and resolve aged customer service open calls within company standards.
• Obtain and extract information from the Health Care Processing System (HCPS) and other systems.
• Develop and maintains positive customer relations and coordinate with various departments to ensure customer requests and questions are handled appropriately and promptly.
• Be accountable and resolve issues by measuring impact, improving, and correcting course.
• Adhere to the call center’s quality assurance guidelines to ensure best-in-class service is provided during all interactions.

Call Center Support

• Thoroughly document information, activities, inquiry outcomes, and changes in the database for accurate tracking and analysis.
• Research and analyze data to address operational challenges and customer service issues.
• Provide external and internal customers with the requested information.
• Communicate with the appropriate departments and identifies service issues.
• Identify inefficiencies within the established processes and suggest possible solutions to save time, reduce risk, and reduce expenses.
• Meet and maintain all KPIs to support the department service metrics and performance objections.

Other

• Maintain regular attendance per employee handbook guidelines.
• Utilize all capabilities to satisfy one mission — to enhance the competitiveness and profitability of our members. Do everything possible to help members succeed by being curious and striving to understand what others are trying to achieve, planning, and executing work helpfully and collaboratively. Be willing to adjust efforts to ensure that work and attitude are helpful to others, being self-accountable, creating a positive impact, and being diligent in delivering results.
• Maintain internet speed of 40 MB download and 10 MB upload and router with wired Ethernet.
• Maintain a HIPAA-compliant workstation and utilize appropriate security techniques to ensure HIPAA-required protection of all confidential/protected client data.
• Maintain and service safety equipment (e.g., smoke detector, fire extinguisher, first aid kit).
• All other duties as assigned.

Physical demands/Work Environment

The physical demands and work environment described here represent those that an employee must meet to successfully perform this job’s essential functions. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions. While performing the duties of this job, the employee is regularly required to communicate with others. The employee frequently is required to move around the office. The employee is often required to use tools, objects, and controls. This noise level in the work environment is usually moderate.