Customer Service Representative

PURPOSE:

The Customer Service Representative provides superior customer service for EHP and its clients using the EHP system and established policies and procedures to manage and direct incoming calls received through the call center. Calls are received from external customers including: providers, hospitals, facilities, health plans, patients, billing services, and internal customers including: UM staff, Claim staff, and Management staff.

ESSENTIAL DUTIES:

• Answer inquiries and resolve problems in a professional and courteous manner. Clarify desired information, research, locate, and provide information within scope of responsibility.
• Identify and escalate unresolved problems to appropriate staff according to established policies and procedures.
• Send emails with basic information and summary of call to appropriate staff when escalating calls.
• Manage and direct incoming phone calls for the Utilization Management Dept. including researching status of authorization requests, verifying membership eligibility, processing authorization extension requests, assisting Primary Care Physicians submit web requests.
• Manage and direct incoming phone calls for the Claim Dept. including researching claim status for providers and billers.
• Transfer authorization requests received through the fax portal to the UM subsystem and assign to appropriate Utilization Management queue as needed. (Job Descriptions: Fax Server Coordinator.)
• Accurately and thoroughly documents all calls received in the appropriate EHP system notes.

• Thorough knowledge of departmental polices and procedures, and companywide objectives.

• Meet and strive to increase productivity standards.

MINIMUM REQUIREMENTS

• Excellent written, verbal, reading comprehension, and listening skills.
• Excellent problem solving skills.
• Ability to manage difficult or emotional customer situations including ability to change approach in a way that best fits the situation and caller.
• Provide management with feedback for ways to improve quality of service.
• Ability to adapt to frequent operational changes and updates.
• Ability to multi-task.
• Due to the nature of the department, must maintain excellent attendance and dependability.
• Interacts with customers, management and co-workers in a tactful, respectful, professional and team oriented manner.

​EDUCATION/TRAINING

• High School diploma required.
• Minimum of six months to one year work related experience in a high call volume customer service environment.
• Excellent telephone skills.
• Basic knowledge of medical terminology in a managed care environment.
• Familiar with fax machines, and copiers.
• Typing and word processing skills required.
• Proficient in navigating through computer systems. Must be proficient in Word and Excel.

LANGUAGE SKILLS

• Ability to communicate and speak effectively before co-workers, management, and external contacts
• Ability to fluently speak, write, and understand English
• Ability to write routine emails and other correspondence
• Ability to speak clearly and concisely over the telephone

CONFIDENTIAL AND SENSITIVE INFORMATION:

• Must properly control the release of proprietary and confidential information

Note that the information above is intended to describe the general nature and level of work being performed by employees, and are not to be construed as an exhaustive list of responsibilities, duties, and skills required of personnel so classified. Furthermore, they do not establish a contract for employment and are subject to change at the discretion of the employer.

Electronic Health Plans works collaboratively with Preferred IPA of California, providing the best possible care management, care coordination, and claims processing services to Preferred IPA and their members. We work with the network’s participating physicians to coordinate patient care when a referral is made to a specialist or hospital for diagnosis and treatment. We coordinate patient care across all aspects of the provider network. In this way, the Electronic Health Plans team makes its best efforts to provide high quality services to its participating physicians and superior health care to its members.

Recommended Skills

• Active Listening
• Adaptability
• Billing
• Call Centers
• Courtesy
• Customer Service