Customer Service Representative I

Customer Service Representative I

Salary Range : $54,647 - $79,237

The expected pay range is based on many factors, such as experience, education, and the market. The range is subject to change.

FLSA Status : Non-Exempt

Department : Customer Service

Reports To : Supervisor, Customer Service

GENERAL DESCRIPTION OF POSITION

The Customer Service Representative I answers inbound calls and makes outbound calls to support Customer Service Department operations in a manner that maintains compliance with Medicare and Medi-Cal regulatory requirements and achieves Call Center service-level objectives.

ESSENTIAL DUTIES AND RESPONSIBILITIES

To perform this job successfully, an individual must be able to satisfactorily perform each essential duty listed below.

• Act as the primary point of contact and liaison for SCFHP members and providers contacting the plan regarding general inquiries, concerns or requests for information.
• Develop a general understanding of all member facing materials, communications and interactions and be prepared to respond appropriately to follow up calls.
• Answer inbound calls and / or place outbound calls in a high call volume environment and work directly with members and providers to accurately and completely answer inquiries involving SCFHP program services and benefits.
• Follow established guidelines and resources to respond to member and provider inquiries and resolve concerns in an accurate, timely, professional, and culturally competent manner.
• Intake, handle and coordinate member grievances, appeals and billing issues, escalating to the Grievance and Appeals department, when necessary.
• Educate members and providers on eligibility, and medical and pharmacy benefits and how to access services in a manner that achieves excellent service standards and maintains high customer satisfaction.
• Use listening skills and judgment to appropriately categorize and accurately document all contacts and follow-up actions regarding member and provider communications and activities in accordance with established guidelines.
• Appropriately handle member and provider requests through alternative channels such as e-mail, voicemail, fax, walk-in, etc. in accordance with established procedures.
• Triage member and provider requests or inquiries for other departments.
• Conduct member surveys as assigned in accordance with established guidelines.
• Attend and actively participate in daily, weekly, and monthly departmental meetings, in-services, training and coaching sessions.
• Identify member / provider issues and trends and report relevant information to management.
• Perform other related duties as required or assigned.

REQUIREMENTS - Required (R) Desired (D)

The requirements listed below are representative of the knowledge, skill, and / or ability required or desired.

WORKING CONDITIONS

Generally, duties are primarily performed in an office environment while sitting or standing at a desk. Incumbents are subject to frequent contact with and interruptions by co-workers, supervisors, and plan members or providers in person, by telephone, and by work-related electronic communications.

PHYSICAL REQUIREMENTS

Incumbents must be able to perform the essential functions of this job, with or without reasonable accommodation :

ENVIRONMENTAL CONDITIONS

General office conditions. May be exposed to moderate noise levels.

EOE

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