Customer Service Representative II

Kaiser Permanente; Duluth (GA); On-site; USD 30,000 - 42,000; Full time

Job summary

Kaiser Permanente is seeking a Customer Service Representative I to support members, patients, providers, and customers with accurate, timely information across multiple product lines and services.

The role emphasizes professional communication, documentation of interactions, and adherence to privacy and compliance standards while resolving inquiries and coordinating service recovery as needed.

Qualifications

• 2.5+ years of customer service experience.
• Typing speed of 30 WPM.
• Excellent written and verbal communication skills.
• Ability to read and respond clearly and effectively.
• Critical thinking and problem-solving abilities.
• Knowledge of systems used within the MSCC.

Responsibilities

• Handle member inquiries across multiple product lines and queues.
• Document conversations according to procedure.
• Maintain privacy and confidentiality of information per policy.
• Provide professional, accurate information and collaborate with internal teams.
• Escalate complex issues to appropriate Health Plan or provider when needed.

Skills

Customer service experience

Typing 30 WPM

Excellent written and verbal comms

Analytical and problem solving

MSCC systems knowledge

Education

High School Diploma or GED

Job description

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.)
  • Premium Billing Enterprise:Billing Inquiry, Make Payment, Complaint, EFT Inquiry, General Reinstatement Request, Service Review.
  • 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.
  • Concierge.
  • 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.

Basic Qualifications:

Experience

• 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.