Customer Service Representative I

Western Growers Health; Irvine (CA); Híbrido; USD 35 000 - 46 000; Tempo integral

Resumo da oferta

Western Growers Health in Irvine, CA is seeking a Customer Service Representative to handle inquiries about insurance benefits, provider contracts, reimbursement programs, eligibility, and claims from members, providers, and employers. The role emphasizes confidentiality, data research, and KPI performance.

The position supports remote/home-based work with required HIPAA-compliant setup and strong communication skills.

Qualificações

• High School diploma or GED and/or one to three years in customer service within a call center environment, preferred.
• Knowledge of Health Benefits and eligibility preferred.
• Clear speaking voice with good communication and telephone skills.
• Strong written communication; ability to learn software and navigate multiple systems.
• Moderate keyboarding with database management skills.
• Strong organizational and time management abilities.
• Adaptable in a constantly changing environment.
• Experience solving standard technical issues for clients.
• Good judgement and negotiation abilities with minimal supervision.
• Ability to learn end-user software programs.
• Ability to meet or exceed department service metrics.
• English fluent (oral and written); bilingual in Spanish preferred.
• Internet with 40 Mbps down / 10 Mbps up; wired home router.
• Designated home office and protective measures for information.
• Functional smoke detector, fire extinguisher, and first aid kit on site.

Responsabilidades

• Respond to general customer questions via telephone, e-mail, and written correspondence regarding benefits, contracts, reimbursement programs, eligibility, and claims.
• Analyze problems and provide information/solutions; resolve aged calls within company standards.
• Operate HCPS and imaging systems to obtain and extract information as needed.
• Develop and maintain positive customer relations and coordinate with internal functions to handle requests timely.
• Meet or exceed department service metrics and document interactions for tracking and trends.
• Identify inefficiencies and suggest improvements to save time, reduce risk, and expenses.

Conhecimentos

Customer service

Call center

Communication

Written communication

Data entry

Time management

Adaptability

Problem solving

English fluency

Spanish preferred

Formação académica

High School diploma or GED

Descrição da oferta de emprego

# Customer Service Representative IFully Remote • Irvine Office - Irvine, CA 92618## OverviewSalary Range$35,288.33 - $45,874.31 SalaryPosition TypeFull TimeTravel PercentageNoneCategoryCustomer Service## Description# Job Description SummaryUnder the direction of the Supervisor, Customer Service, this position is responsible for meeting KPIs while responding to general customer inquiries regarding insurance benefits, provider contracts, reimbursement programs, eligibility, and claims from members, providers and employers in a confidential, professional, and ethical manner. The incumbent will also research and analyze data to address standard operational challenges and issues within the Customer Service department.# Duties And Responsibilities*Customer Advocate** Respond to general customer questions via telephone, e-mail, and written correspondence regarding insurance benefits, provider contracts, reimbursement programs, eligibility, and claims in a confidential, professional, and ethical manner.* Analyze problems and provide information/solutions.* Research and resolve aged Customer Service open calls within company standards.* Operate in the Health Care Processing System (HCPS), Imaging systems, and all systems necessary to obtain and extract information with proficiency and skills.* Develop and maintain positive customer relations and coordinate with various functions within the company to ensure customer requests and questions are handled appropriately and in a timely manner.* Be accountable when you uncover an issue or trend by helping to assess and report its impact, making improvements, and course-correcting along the way.* Follow quality guidelines to provide exceptional customer support and ensure scores meet or exceed expectations.*Call Center Support** Accurately document database activity and customer interactions for tracking and analysis to identify trends and address operational and service issues.* Research and analyze data to address standard operational challenges and customer service issues.* Provide customers with requested information, including difficult and upset customers.* Meet or exceed all department and performance service metrics.* Communicate with the appropriate departments and identify service issues.* Identify inefficiencies within the established processes and suggest possible solutions to save time, reduce risk, and/or reduce expenses.*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, be self-accountable, create a positive impact, and be 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.## Qualifications# Qualifications* High School diploma or GED and/or one (1) to three (3) years of experience in customer service within a call center environment, preferred.* Knowledge of Health Benefits and eligibility preferred.* Good communication and telephone skills with a very clear and concise speaking voice.* Proficient written communication skills with the ability to learn new software and navigate multiple systems at once.* Moderate keyboarding skills including proficiency with database management.* Proficient organizational and time management skills.* Adaptive in constantly changing environment.* Skilled in researching and resolving standard technical issues or client problems as they arise.* Good judgement, negotiation abilities and capacity to work with minimal supervision.* Capable to learn and understand company’s end-user software programs.* Ability to meet or exceed departmental service metrics.* Fluent in English (oral and written) required. Bilingual in Spanish preferred.* Internet access provided by a cable or fiber provider with 40 MB download and 10 MB upload speeds.* Home router with wired Ethernet (wireless connections and hotspots are not permitted).* A designated room for your office or steps taken to protect company information (e.g., facing computer towards wall, etc.)* A functioning smoke detector, fire extinguisher, and first aid kit on site.