Customer Service Representative Job in Worcester 01609, Massachusetts Us
We are seeking business-oriented, customer service driven professionals to provide high quality service to customers. As a Customer Service Representative, you will be the primary point of contact for our customers, managing their healthcare accounts, utilizing our proprietary applications. Interested candidates must have excellent phone etiquette and communication skills along with the ability to build solid business relationships.
Job Description:
• Function as the front-line contact for all members by responding to a high-volume of incoming calls from members and prospective members
• Respond accurately to calls related to status changes, transportation guidelines, member eligibility/managed care status, prior authorization, and pharmacy guidelines/procedures
• Provide members with all current healthcare options available to promote member choice within the assigned network or managed care providers, using knowledge gained through training and other sources
• Conduct a thorough health care need assessment with members, including existing and anticipated need of all eligible family members, as needed
• Complete all related paperwork and necessary forms including enrollment forms, member requests and personal reimbursement within established timeframes and guidelines
• Perform accurately all data entry function to reflect member or provider activity/transactions
• Facilitate the resolution of non-clerical issues related to client and provider compliance/participation according to established policy and protocols
• Ability to respond to and resolve customer problems/needs
• Ability to analyze problems and develop solutions
Job Requirements:
• Background experience in customer services, human services, health care or service-related field
• Experience with a proven track record in meeting or exceeding performance standards, schedule adherence and job skill assessments
• Excellent organizational, written and verbal communications skills
• Ability to perform comfortably in a fast-paced, deadline-orientated work environment
• Ability to successfully execute proficiency in MS Window applications, Web-based applications and the ability to utilize multiple applications simultaneously
Job Preferences:
• Prefer knowledge or provider/insurance billing procedures and remittance advices
• Healthcare call center experience
• Bilingual in Spanish, Creole, Chinese, Vietnamese, Albanian, Arabic, Russian, Hindu, Portuguese or any other language