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Customer Service Representative

Company: Health One Alliance, LLC
Location: Dalton
Posted on: January 16, 2022

Job Description:

Job PurposeThe Customer Service Representative addresses inquiries, questions and concerns in all areas including enrollment, eligibility, claims, benefit interpretation, and referrals/authorizations for medical care. The position is responsible for receiving, responding to, and directing member, broker and provider phone calls and other communications and provides available information upon request and escalates issues as appropriate.RequirementsDuties and ResponsibilitiesReceives customer calls or inquiries, which include potential/current/previous members, brokers and providers, and routes appropriatelyProvides timely and accurate information to customersProcesses customer requests according to established department policies and proceduresCompletes research and investigative activities to address customer inquiriesWorks closely with other departments to gather informationProvides timely feedback to customers through outbound calling, email, mail or faxProvides timely feedback to the company regarding service failures, systemic issues or customer concernsAssists in the completion of special projectsAssists in the documentation, evaluation and revision of department policies and proceduresMeets or exceeds service level agreements in call center metricsAttends and participates in meetings and trainings as requiredRegular and predictable attendanceConsistently demonstrates compliance with HIPAA regulations, professional conduct, and ethical practiceMaintains work area in a clean and orderly condition and ensures safe operating conditions within area of responsibilityWorks to encourage and promote Company culture throughout the organizationOther duties as may be assignedQualificationsRequires a high school diploma or its equivalentpreferredBilingual preferredAbility to learn quickly and be self-motivatedKnowledge of healthcare billing and claims preferredInsurance experience preferredCompetenciesEthics - Honest, accountable, maintains confidentiality.Reliability - The extent to which the employee can be depended upon to be available for work, do it properly, and complete it on time. The degree to which the employee is reliable, trustworthy, and persistent.Sense of Urgency - Meets deadlines, establishes appropriate priority, gets the job done in a timely manner.Customer Service - Works will with customers, promotes a positive image of the company, strives to solve issues raised by customers.Communication Skills - Possesses effective communication skills: oral, written, listening.Computer Skills - Skilled with computers, takes advantage of new technology, learns new tools quickly, uses technology to enhance job performance.Conflict Management - Good listener, committed to finding solution to problems, works well with difficult people.Cooperation - Willingness to work harmoniously with others in getting a job done. Readiness to respond positively to instructions and materials.Initiative - Takes action, seeks new opportunities, strives to see projects to completionJob knowledge - Knowledge of products, policies and procedures; OR knowledge of techniques, skills, equipment, procedures, and materials.Organizational Skills - Information organized and accessible, maintains efficient workspace, manages time well.Problem Solving - Displays ability to recognize a problem, trouble shoots to ascertain the extent of the problem, and selects appropriate alternative to investigate or resolve the problem.Physical, Mental, Environmental & Working ConditionsSignificant amount of sitting and typing. Moderate amount of walking and writing. Moderate to significant amount of stress in meeting deadlines and dealing with day-to-day events in the execution of job duties. Needs flexibility and adaptability to change. Candidate must be self-disciplined and a self-starter and able to work independently with a flexible work schedule.

Keywords: Health One Alliance, LLC, Chattanooga , Customer Service Representative, Other , Dalton, Tennessee

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