Customer Service Representative

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Job description

Title: Customer Service Representative
Location: Arlington, VA (100% remote)
Duration: 6 Months

Start Date: new hire training begins on Monday 12/9/24!
Required Schedules: all of the below are full-time, Monday through Friday
Training (4-6 weeks): 8 am-4:30 pm CST
Long-term: hours vary between 8 am-6 pm CST

IMPORTANT SCHEDULE NOTES:
The department selects your schedule where you MUST be available during the above times (standard call center requirement)
SATURDAY shifts are a possibility, 9 am-1 pm CST: you will be notified in advance and your schedule will be adjusted accordingly
Any unexcused absences and/or time missed could result in the immediate termination of your assignment

Assignment Duration:
6 months, option for temporary-to-hire depending on performance AND availability of permanent openings

Important Training Notes
Includes a virtual classroom environment with trainers who have experience working within the Client Customer Service Operations (CSO) call center
Due to the amount of information you will receive in training, 100% attendance is required and any extensive time missed in training may result in immediate termination of your contract!
If you miss any unexcused time during training, then you will be evaluated for release of your position (more than 12 hours could result in immediate termination!)

What You'll Be Doing
Customer Service Representatives (CSR's) will be working with and providing support to health plan members, providers and/or their representatives
Leadership rewards and recognizes CSR's regularly for performance in an environment that challenges while providing clear direction and support to foster success in the role.
Answer and manage inbound inquiries regarding health plan benefits and claims, eligibility, medical and other healthcare procedures, billing and payments and other related topics from customers in a prompt, courteous manner.
Conduct outbound and/or return calls to customers, as necessary.
Ask appropriate questions and listen actively to identify specific questions or issues to provide appropriate responses and the type of assistance the customer needs while documenting relevant information in a clear and concise manner in computer systems.
Communicate and partner with customers tactfully and empathetically to resolve issues, using clear language to translate healthcare-related jargon and complex processes into simple, step-by-step instructions customers can comprehend and act upon.
Handle and process customer complaints/grievances while applying appropriate conflict management skills to de-escalate potentially stressful situations.
Meet the performance goals established for the position in the areas of efficiency, accuracy, quality, member satisfaction, and attendance.
Adhere to all applicable department, organization, and/or regulatory policies and procedures.
Read, comprehend, and verbalize processes and procedures of the organization and of health insurance coverage.
Trainees will be required to attend the entirety of training, successfully complete the required training schedule, and demonstrate proficiency of the material at the end of training.

The Experience You'll Need - Required!
High school diploma or GED
At least 1 year of call center experience
Ability to handle a heavy call volume of 50-100 calls daily
Demonstrated ability in using computer and Microsoft applications, which includes strong keyboard and navigation skills, ability to type 35 WPM, and learn new computer programs
Ability to work regularly scheduled shifts within hours of operation including the training period, where lunches and breaks are scheduled, with the flexibility to adjust daily schedule and work over-time and/or weekends, as needed
Demonstrated ability to take an educative approach, listen skillfully, collect relevant information, determine immediate requests and identify the current and future needs of the customer, answering questions and informing of health plan policies, procedures, or decisions
Ability to maintain strict confidentiality of protected health information

Additional Experience that is Preferred
2+ years at a health plan, TPA, or related call center setting
Knowledge of managed care, Commercial, Marketplace, Medicaid and/or Medicare programs; knowledge of medical policy benefits and exclusions
Bilingual in Spanish & English: validated via bilingual assessment upon offer acceptance
differential in pay if they qualify!

At-Home Workspace Requirements
This requires a quiet, private workspace without noise and distractions
Set aside a dedicated location within your home outside of common areas to avoid background noise while on calls with our members and/or providers
Please be sure that dependent and/or pet care has been resolved before you begin your new position
Working at home is not a replacement for daycare for children and/or pets
Your workspace must be able to always maintain privacy during your working hours
This means your area must be in a secured locked location free from any distractions or ability to disclose HIPPA or PHI information
You may not work remotely in a public place (Coffee shop, park, library, airport, etc), which also includes outside of the country, including any US territory
If you need to work at a different location, this must be preapproved by your leader
Your equipment should not be moved from your home location without preapproval by your leader, as this runs the risk of loss of HIPPA and/or PHI information

New Hire CSO CSR Technology Requirements
All team members are required to have a smartphone so that they can access Microsoft Multi-Factor Authentication & Microsoft Teams
Due to the use of the NICE application for servicing our inbound and outbound calls, requires that all CSR team members have an internet service that provides 100 MBPS fiber optic, high speed service and must be able to connect directly to your router via an ethernet cord
The use of WIFI on your laptop will be disabled, as using NICE will cause dropped calls, and inability to hear voice through your headset
The below internet services are NOT compatible with the NICE application and are, therefore, NOT acceptable for this role:
4G, 5G, LTE or Satellite Internet service, as they are an escalated WIFI / Hot Spot service

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