Job Description

Customer Service Representative 1

The Customer Service Representative 1 at Healthplan Services Inc serves a critical function in maintaining excellent communication and service delivery to our valued customers. This remote position requires engaging with members, providers, and internal teams to resolve complex health insurance inquiries including claims, coverage details, benefits, and deductibles. Through empathy, accuracy, and professionalism, this role upholds the company's reputation for providing top-tier support while ensuring clear and precise information is delivered to all stakeholders.

Key Responsibilities:

• Accurately document and maintain records of all customer interactions using established systems, ensuring compliance with company and client standards.
• Provide detailed explanations and education to members and providers regarding eligibility, policy benefits, claims payments, and authorization processes, enhancing customer understanding and satisfaction.
• Promote and guide customers in the use of self-service tools to optimize their experience and encourage efficient resolution.
• Analyze patient activity and claims information for resolving benefit inquiries, adjusting claims data when necessary to attain first-contact resolution.
• Effectively route complex inquiries beyond scope to appropriate departments, ensuring timely follow-up and resolution tracking.
• Consistently meet or exceed individual, departmental, and client-specific performance goals, contributing to the overall success of the customer support team.
• Adhere to all client policies, including administrative and contractual guidelines, safeguarding compliance and service quality.
• Maintain a dedicated work environment with a private office space and a high-speed internet connection to support remote work productivity and privacy.

Qualifications and Skills:

• Ability to work Monday through Friday from 12:30 PM to 9:00 PM EST, with an initial training schedule of 10:00 AM to 6:30 PM EST lasting three to four weeks.
• High School Diploma or GED is required and will be verified.
• Minimum of one year customer service experience preferred, ideally within healthcare or related fields.
• Strong verbal and written communication skills including professional email and chat etiquette.
• Demonstrated problem-solving skills with strong reading and analytical abilities.
• Proficiency in basic computer skills and understanding of technology such as USB connectivity.
• Highly organized, detail-oriented with a commitment to delivering high-quality work.
• Ability to work independently with sound decision-making capabilities while complying with company standards.
• Exceptional attendance record required with no absences for the first 60 days of employment.

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