Customer Service Representative I (4580)

Purpose of Position:

• The Customer Service Rep I handles calls from customers to resolve, educate, follow-up and respond to questions regarding California Choice plan administration and procedures for groups, members, brokers and general agencies.

Essential Functions:

• Understanding of company policies and procedures as they apply to California Choice plans
• Answers questions via telephone or email from groups regarding new hires, billing, rates, supplies, administrative procedures, etc.
• Educates, via telephone or email, employees/dependents regarding ID cards, administrative procedures, dependent coverage, address changes, etc.
• Follows-up on calls and emails from brokers regarding problems that their groups are experiencing with providers.
• Ability to interact with brokers, general agents and sales representatives on a daily basis and must be able to answer questions regarding California Choice processes.
• Responds to calls from providers to confirm eligibility and benefits
• Verifies enrollments and resolves issues with carriers.
• Expedites processing of members enrollment with carrier if urgent services are needed.
• Review and submit appeal requests from groups.
• Review /Audit group billing and explain to clients in clear and accurate manner.
• Document calls in call tracking system.
• Ability to work in a paperless environment with the Doc Link system.
• Departmental standard requires each Customer Service Representative to provide Service of Unequalled Excellence to all callers by maintaining an average of 90% or greater on Call Reviews.
• Answer at least 100% of the daily call volume average.
• Provide clear and explicit documentation while maintaining percentage at a level of 90% or higher daily in applicable databases (i.e. Doc Link and Opportunity)
• Make busy time of 20 minutes or less per day.
• Meet department standards for quality and quantity of work.
• Meet department and team standards for turnaround times.
• Adhere to all HIPAA (Health Insurance Portability and Accountability Act) and PHI (Personal Health Information) guidelines.
• On-site or remote regular attendance and punctuality are essential functions of the job.
• Performs other business tasks or functions as assigned.