Customer Services Specialist

SGS Consulting; Lansing (MI); On-site; USD 34,000 - 50,000; Full time

Job summary

SGS Consulting seeks a dedicated customer service professional to respond to inquiries, educate members on healthcare policies, and maintain accurate inquiry history. You will work within HIPAA guidelines, handle escalations, and collaborate with internal departments to resolve issues.

The role requires strong communication, problem-solving, and the ability to manage multiple tasks with a focus on service excellence. Flexible shifts may be required, and ongoing training is provided.

Qualifications

• Minimum 2 years of recent Customer Service or Call Center experience within the last 3 years.
• Demonstrates integrity, patience, maturity, empathy, tact and diplomacy.
• Strong problem-solving, flexibility, good judgment, and service excellence.
• Proficient in using a PC and Microsoft programs.
• Basic understanding of health insurance delivery systems and claims billing.
• Ability to work flexible shifts, including evenings and weekends when required.

Responsibilities

• Respond to inquiries by telephone, mail and in person; research and answer inquiries, complaints and appeals following department standards, policies and procedures; direct inquiries to supporting departments for action and resolution.
• Educate members on policies, procedures, product offerings, benefit plans and coverage related to HAP products.
• Document all inquiries to track history and trends.
• Maintain confidentiality per Privacy and HIPAA regulations.
• Attend training and development to enhance skills and performance.
• Manage workflow inbox and cases to ensure timely response and follow-up.
• Interact with support departments to meet member needs.
• Develop relationships with inter-departments and stay updated on policy changes affecting servicing of members/customers.
• Attend training and continuing education offered by Customer Service to maintain skills.
• Interact with providers and staff to obtain information for resolving inquiries and complaints.
• Ensure compliance with department and corporate standards and procedures.
• Suggest process improvements based on observations and trends in customer interactions.
• Coordinate with departments on projects, enrollment periods, outreach activities and initiatives.
• Perform other related duties as assigned.

Skills

Customer service experience

Dependable

Integrity and empathy

Problem solving and service excellence

PC fluency and Microsoft programs

Understanding of HMO/PPO/POS and claim

Flexible shifts and overtime

Education

Associate’s degree

Medical Terminology course

Tools

Microsoft Office

Job description

Job Responsibilities:

• Respond to inquiries by telephone, mail and in person; research and answer inquiries, complaints and appeals by following all department standards, policies and procedures; direct inquiries to supporting departments for appropriate action and resolution.


• Educate existing and potential members on policies, procedures, product offerings, benefit plan and coverage provisions related to all HAP products.


• Document all incoming inquiries accurately in to track member inquiry history and trends.


• Practice and maintain confidentiality to Privacy and HIPAA regulations.


• Proactively seek training and development to enhance skills and abilities.


• Monitor workflow inbox and outstanding cases to ensure that all inquiries receive an appropriate response in a timely manner; contact members (by phone/or in writing), as needed, to ensure timely resolution and follow-up to inquiry.


• Interact with support departments in a professional manner to ensure member needs are met.


• Develop and maintain strong business relationships with inter-departments; continue to self-educate on changes in policies and procedures that occur in other departments which could have an impact on department operations and the servicing of member/customers.


• Attend training and development sessions or continuing education opportunities offered by Customer Service and maintain enhanced skill levels and performance.


• Interact with providers and their staff to obtain information for resolving customer inquiries and complaints.


• Ensure and maintain compliance of all department and corporate standards, policies and procedures.


• Recommend process improvements based on observations and trends identified while interacting with internal and external customers.


• Coordinate and assist with various departmental projects, member enrollment periods, outreach activities and corporate initiatives.


• Perform other related duties as assigned.

Skills:

• Minimum of two (2) years of recent Customer Service or Call Center experience within the last three years.


• Must be dependable.


• Demonstrate a high degree of integrity, patience, maturity, empathy, tact and Diplomacy.


• Demonstrate problem solving skills, flexibility, good judgment and ability to provide service excellence.


• Demonstrate efficiency in using a PC and various Microsoft programs.


• Fundamental understanding of HMO/PPO/POS delivery system and claims billing.


• Must be able to work flexible shifts, overtime including evenings and weekends as requested and/or scheduled.

Education/Experience:

• Required Education: Course in Medical Terminology (required completion within six months post-employment).


• Associate’s degree


• A minimum of four (4) years of recent and related work experience in customer service capacity may be considered in lieu of the degree.