Government Programs Customer Service Representative

Promptly and professionally responds to member, client and provider questions through multiple channels, including, but not limited to telephone, email, fax and U.S. mail communication using proper etiquette, grammar, punctuation, etc. Clearly and accurately communicates all eligibility, benefit, claim status and payment information related to caller’s questions. Properly identifies the reason(s) for the call and provides appropriate resolution to inquiries and complaints within specified timeframes and guidelines established by regulatory agencies or client contracts. Informs and assists callers with grievance and the claims appeals processes, as necessary. Clearly, accurately and thoroughly documents information in the customer relationship management system to ensure all relevant details of the phone call are captured. Understands the importance of adhering to regulatory requirements. Meets or exceeds quality standards. Meets or exceeds call center metrics.