Customer Service Representative II

Kaiser Permanente; Duluth (GA); Remote; USD 35,000 - 45,000; Full time

Job summary

Kaiser Permanente in Georgia (Duluth) seeks a Customer Service Representative to support members, patients and providers with accurate, timely information and handling inquiries across multiple product lines.

The role requires resolving complex inquiries, documenting conversations, and collaborating with internal teams to ensure service quality while upholding privacy and conduct standards.

Qualifications

• Minimum two-and-a-half years of customer service experience.
• Six months as a Customer Service Representative I within the Member Service Contact Center (MSCC).
• High School Diploma OR GED required.
• Must pass Classification Assessment.
• Minimum typing speed of 30 WPM (typing test current within one year).
• Excellent written and verbal communication skills.
• Demonstrated analytical and problem-solving skills.

Responsibilities

• Handle member inquiries across multiple service areas with accuracy and professionalism.
• Document conversations with members according to procedure.
• Respond to internal/external inquiries and coordinate with health plan, medical group and facilities.
• Evaluate data to resolve complaints and coordinate service recovery.
• Adhere to compliance and privacy standards while protecting organizational assets.

Education

High School Diploma or GED

Job description

Job Summary

The Customer Service Representative is responsible for increasing customer satisfaction and retention by providing members, customers, patient and providers with accurate, consistent, timely and meaningful information. They will provide support to members with an increased level of complexity in inquiries and issues as they utilize the KP plan and provider services, continuing to build rapport and collaborative relationships with current and prospective members in accordance with compliance guidelines.

• Available to handle member inquiries regarding:
• Member Core:Facility Inquiry, Web Support, Promote KP.Org, Order ID Card, Complaint, ID Card Inquiry, Service Review.
• Member Advance:Eligibility Inquiry, Benefit Inquiry, General, Complaint, Correspondence Inquiry, Add/Remove Dependent, Service Review, New Member Experience, Internal Regional Request, IVR Defaults.
• Medicare (For up to two (2) regions.)
• KPC Billing1095 Tax Form, SLP* (escalations to Tier 3).
• Service Billing:Billing Inquiry, Make Payments, Complaints, Payment Plan, General, Service Review.
• Claims:Claim Inquiry, Claim Referral Inquiry, Complaint, General, Provider Demographic Update, Service Review.
• PSNAP: Post Stabilization Notification and Authorization Project.
• Represents Health Plan by answering and documenting all incoming contacts to determine their nature and to respond to complex calls related to specialized product lines or queues.
• Responds professionally to inquiries from internal/external customers.
• Initiates contact with the appropriate Health Plan, medical group and facility personnel to obtain information relevant to the concern or inquiry as needed.
• Evaluates data to determine and implement the appropriate course of action to resolve the complaint and/or coordinate service recovery.
• Documents conversations with members according to procedure.
• Follows established procedures to meet customer/member needs.
• Required to effectively interact with diverse work units and relevant organizational departments.
• Has substantial understanding of the assigned skills and applies knowledge and skills to complete a wide range of tasks.
• Ability to understand relevant policies, processes and customers.
• Assist the department in meeting customer needs and reaching department expectations.
• Completes required training and understand how to use tools available to recall necessary information.
• Develop a full awareness of the way performance and actions affect members and Member Service Contact Centers (MSCC) performance guarantees (call handling, first call resolution, complaint resolution compliance, member retention, and return contact as warranted).
• Promotes, ensures and provides customer service to internal/external customers by demonstrating skills which are consistent with the organizations philosophy of providing extraordinary customer relations and quality service.
• Consistently supports compliance and the Principles of Responsibility (Kaiser Permanentes Code of Conduct) by maintains the privacy and confidentiality of information, and protects the assets of the organization.
• Performs other relevant duties as required.

This position represents {1} openings.

Job Summary

The Customer Service Representative is responsible for increasing customer satisfaction and retention by providing members, customers, patient and providers with accurate, consistent, timely and meaningful information. They will provide support to members with an increased level of complexity in inquiries and issues as they utilize the KP plan and provider services, continuing to build rapport and collaborative relationships with current and prospective members in accordance with compliance guidelines.

Essential Responsibilities

• Available to handle member inquiries regarding:
• Member Core:Facility Inquiry, Web Support, Promote KP.Org, Order ID Card, Complaint, ID Card Inquiry, Service Review.
• Member Advance:Eligibility Inquiry, Benefit Inquiry, General, Complaint, Correspondence Inquiry, Add/Remove Dependent, Service Review, New Member Experience, Internal Regional Request, IVR Defaults.
• Medicare (For up to two (2) regions.)
• KPC Billing1095 Tax Form, SLP* (escalations to Tier 3).
• Service Billing:Billing Inquiry, Make Payments, Complaints, Payment Plan, General, Service Review.
• Claims:Claim Inquiry, Claim Referral Inquiry, Complaint, General, Provider Demographic Update, Service Review.
• PSNAP: Post Stabilization Notification and Authorization Project.
• Represents Health Plan by answering and documenting all incoming contacts to determine their nature and to respond to complex calls related to specialized product lines or queues.
• Responds professionally to inquiries from internal/external customers.
• Initiates contact with the appropriate Health Plan, medical group and facility personnel to obtain information relevant to the concern or inquiry as needed.
• Evaluates data to determine and implement the appropriate course of action to resolve the complaint and/or coordinate service recovery.
• Documents conversations with members according to procedure.
• Follows established procedures to meet customer/member needs.
• Required to effectively interact with diverse work units and relevant organizational departments.
• Has substantial understanding of the assigned skills and applies knowledge and skills to complete a wide range of tasks.
• Ability to understand relevant policies, processes and customers.
• Assist the department in meeting customer needs and reaching department expectations.
• Completes required training and understand how to use tools available to recall necessary information.
• Develop a full awareness of the way performance and actions affect members and Member Service Contact Centers (MSCC) performance guarantees (call handling, first call resolution, complaint resolution compliance, member retention, and return contact as warranted).
• Promotes, ensures and provides customer service to internal/external customers by demonstrating skills which are consistent with the organizations philosophy of providing extraordinary customer relations and quality service.
• Consistently supports compliance and the Principles of Responsibility (Kaiser Permanentes Code of Conduct) by maintains the privacy and confidentiality of information, and protects the assets of the organization.
• Performs other relevant duties as required.

Experience

Basic Qualifications

• Minimum two-and-a -half (2 1/2) years of customer service experience to include six (6) months as a Customer Service Representative I within the Member Service Contact Center shared service.

Education

• High School Diploma OR General Education Diploma (GED) required.

License, Certification, Registration

• N/A

Additional Requirements

• Must pass Classification Assessment.
• Minimum typing speed of 30 WPM (Typing test must be current within one (1) year of the posting period.
• Excellent written and verbal communication skills.
• Demonstrated analytical and problem-solving skills.
• Strong knowledge of systems used within the MSCC.
• Ability to read and respond briefly, clearly and effectively.
• Ability to think critically and problem solve.
• Manage own work with minimal direction.
• Must pass knowledge checks while in training.

Preferred Qualifications

• N/A.

Kaiser Permanente is an equal opportunity employer committed to fair, respectful, and inclusive workplaces. Applicants will be considered for employment without regard to race, religion, sex, age, national origin, disability, veteran status, or any other protected characteristic or status.

Primary Location: Georgia,Duluth,Duluth Contact Center

Scheduled Weekly Hours: 40

Shift: Evening

Workdays: Mon, Tue, Wed, Thu, Fri, Sat

Working Hours Start: 12:00 PM

Working Hours End: 09:00 PM

Job Schedule: Full-time

Job Type: Standard

Worker Location: Remote

Employee Status: Regular

Employee Group/Union Affiliation: GTC|UFCW|Local 1996

Job Level: Entry Level

Department: Membership Contact Center GA - Call Center - 0315

Pay Range: $25.33 - $32.72 / hour

Kaiser Permanente strives to offer a market competitive total rewards package and is committed to pay equity and transparency. The posted pay range is based on possible base salaries for the role and does not reflect the full value of our total rewards package. Actual base pay determined at offer will be based on labor market data, internal alignment, and a candidate's years of relevant work experience, education, certifications, skills, and geographic location.

Travel: No

Work Setting: Remote

Worker location must align with Kaiser Permanente's Authorized States policy.

Kaiser Permanente is an equal opportunity employer committed to fair, respectful, and inclusive workplaces. Applicants will be considered for employment without regard to race, religion, sex, age, national origin, disability, veteran status, or any other protected characteristic or status.