Customer Care Representative

WHO WE ARE:

GlobalHealth is a fast-growing Medicare Advantage HMO health insurer. We aspire to be the employer of choice in our industry, attracting and retaining a highly talented workforce. Our passion is Genuine Care and Optimal Health for the members we serve. We are unique by providing high touch, high value and a partnership to our members. We go above and beyond to provide personalized, engaging, and responsive services to our members. We work hard to offer affordable health insurance coverage with the benefits people truly want and need. It is our hope to be more than just a health insurance company we want to be long-term partners with our members. We are looking for future employees who exude our core values of taking accountability through ownership, being driven, innovative and who have a passion for continuous learning.

WHO YOU ARE:

The Customer Care Representative is devoted to providing effective customer service and issue resolution to all callers. This position works within a team oriented, call-center environment to accomplish department goals.

ESSENTIAL JOB FUNCTIONS:

• Assists with incoming calls October 1 to March 31 from 8 am to 8pm, 7 days a week and April 1 to September 30 from 8am to 8pm, Monday through Friday.
• Must maintain confidentiality of business information, including Protected Health Information (PHI), as required by HIPAA and company policy.
• Adheres to department policies and procedures including but not limited to call metrics, sufficient call documentation, and other departmental expectations.
• Effectively use of telephony equipment, company systems/software, and any other tools used within the company.
• Answer health plan related questions from inbound member and provider calls.
• Ascertains reason for calls and assists customers with their questions or concerns in a manner providing them with immediate and accurate information, focusing on first call resolution.
• Follows up with customers when first call resolution is unachievable.
• Coordinates with other departments to effectively resolve the customers concern or complaint.
• Ascertains type of call and assists customers with their complaints, appeals and/or grievances in a manner providing them with immediate acknowledgement, accurate information and focusing on obtaining details of the customers experience.
• Assists in connecting customers with an interpreter service through an outbound conference call, whenever necessary
• Responds to and completes Web/Electronic/Mailed/Faxed customer inquiries.
• Other duties as assigned

EDUCATION AND EXPERIENCE:

• High school diploma or GED required
• Some completed college courses in health care, business, or related field preferred.
• 3 years of customer service experience in a call-center environment and/or experience in healthcare or insurance industry required
• Computer proficiency with MS Office Suite (Word, Outlook, Excel)
• Previous experience in a fast-paced call center, managed care environment and/or Medicaid and/or Medicare focused position preferred
• Basic knowledge of Medicare and terminology preferred

KNOWLEDGE, SKILLS AND ABILITIES:

• Exceptional customer service skills including effective and efficient problem solving and analyzing skills
• Ability to maintain higher than average attendance record
• Requires excellent active listening and oral and written communication and grammar skills.
• Ability to facilitate conversations with others and establish an understanding of the customer's issue/reason for contact
• Ability to perform essential job functions with high degree of independence, flexibility, and creative problem-solving techniques
• Ability to maintain control of the call by de-escalating issues and instilling confidence that the resolution has been found.
• Ability to function effectively under stress of conflicting demands on time and attention and, sometimes, under duress from difficult personalities
• Ability to multi-task, set priorities, and manage time effectively
• Ability to maintain a positive attitude.
• Maintains a professional and respectful relationship with all coworkers, vendor representatives, supervisors, managers, customers, and client representatives.

WORK ENVIRONMENT:

The work environment is within a fast-paced call center with a requirement to be talking on the phones 90% or more of the workday.

TRAVEL:

This position does not require work travel.

SUPERVISORY RESPONSIBILITY:

This position does not contain Supervisory responsibilities.

OTHER DUTIES:

This job description is not designed to cover or contain a comprehensive listing of activities, duties or responsibilities that are required of the employee for this job. Duties, responsibilities, and activities may change at any time with or without notice.