Position Summary: Receive inbound calls from members who are enrolled in a Medicare, Medicare Advantage or Medicaid plan. Assist those members with taking orders for items sponsored by the plan, update account information, provide plan information and resolve issues with utilization of the plan benefit. Place outbound calls as directed and necessary for member resolution. Work takes place in a standard office environment. Position could be onsite or remote (if applicable). Position requires sitting for a long period of time using a computer. Tasks involve the ability to reach with hands and arms, talk and hear. Specific vision abilities required by this job include: close vision, distant vision, color vision, peripheral vision, depth perception and ability to adjust focus.
Responsibilities: Update account information such as change of address or phone numbers. Research members that have a benefit disputesEducate members on how the plan works, including benefits, participating retail markets (if applicable) and items or products and services covered through the benefit. Submit catalog requests and retail card replacements to be mailed out upon member request.Educate and assist members with website registration, utilization and how to order through the online ordering app.Educate and assist members to use the mobile app.Make concise and detailed notations as it pertains to member records.Answer questions pertaining to mailings sent out by the Health plan.Communicate with coworkers, management, staff, customers, and others in a courteous and professional manner.Conform with and abide by all regulations, policies, work procedures and instructions.Respond promptly when returning telephone calls and replying to correspondence.Act, dress, and behave in a professional manner to reflect a positive image of the company. Other Responsibilities: Responsible for compliance with all federal, state and local laws, rules and regulations affecting the Company.Responsible for participating in quality assurance, compliance and in-service and continuing education activities as requested by the Company.Responsible for performing other duties and responsibilities as required. Knowledge, Skills and Abilities: Ability to provide clear and accurate information and follow up when necessaryStrong attention to detail.Ability to solve problems - identifies and resolves problems in a timely manner, gather and analyze information skillfully, develop alternative solutions, work well in a group problem solving situation, and use reason even when dealing with emotional topics.Requires technical skills - Assess own strengths and weaknesses, pursue training and development opportunities, strive to continuously build knowledge and skills, and share expertise with others.Ability to read and interpret documents such as safety rules, operating and maintenance instructions, and procedure manuals. Skill in communication and interpersonal skills sufficient to exchange or convey information and to receivework direction.Ability to write routine reports and correspondence. Ability to speak clearly and concisely over the phone.Ability to apply common sense understanding to carry out instructions furnished in written, oral, or diagram form. Skill in dealing politely, tactfully and firmly with a wide range of people and personalities.Skill in organizing and prioritizing tasks. Must be able to multi-task and think quickly. Ability to communicate well orally and in writing in the English language.Ability to work in an environment with many interruptions.Working efficiently in a stressful environment. Requirements: High school diploma or equivalent.Minimum 6 months customer service experience is preferredPrevious customer service experience is preferred or any equivalent combination of related training and experience.Above average computer skill is required, including the ability to work in a Windows environment and multitask within multiple software programs simultaneously.Communicate with coworkers, management, staff, customers, and others in a courteous and professional mannerConform with and abide by all regulations, policies, work procedures and instructionsKnowledge of customer service best practices and principles.Excellent data entry and typing skills.Superior listening, verbal, and written communication skillsAbility to handle stressful situations appropriately, while demonstrating empathy.Resourceful, great at solving unstructured problems with little to no supervision in a fast-paced, high stakes environment.Team Player: Demonstrates a strong ability to contribute to the business along with business unit team members and managers; establish collaborative relationships with peers.Possess strong interpersonal skills and the ability to establish, develop, and maintain business relationships.Excellent written and verbal skills