Provides a world-class customer service experience by trouble shooting and resolving complex customer inquiries from members, employers, and providers.
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- Research, resolve and respond to inquiries and correspondence via telephone, written communication and/or in person. Inquiries will be from members, providers, group leaders and internal staff regarding a diverse range of topics including, but not limited to, contract benefits, changes in coverage, eligibility, claims, provider networks, payments and appeals.
- Uses critical thinking skills to determine course of action needed to resolve inquiry or complaint.
- Must be comfortable being monitored for level of efficiency, accuracy and customer satisfaction and must be able to meet performance standards to achieve both individual and department goals.
- Must be able to communicate effectively with appropriate tone and content. Customer Service calls are recorded to ensure accuracy and to provide a tool for feedback for reps.
- Must be able to balance workload to ensure timely and accurate response to both internal and external customers.
- Initiate claims adjustments and update enrollment information through the on-line systems as determined necessary through inquiries.
- Must demonstrate the ability to listen, talk, type and perform research simultaneously using various research channels, both online and hard copy.
- Must be able to follow a call guide.
- Ability to provide education to our members and providers on various avenues available to them to obtain information such as the website.
- Promote good working relations and positive work environment while acting as a role model to coworkers.
- Must remain positive, pleasant, and helpful under a wide variety of circumstances including angry customers. Employee must be able to be on telephone constantly except for breaks and lunches and must wear a headset that plugs into the phone. Communication by telephone and direct personal contacts will consume 95% of the workday. Must operate a Personal Computer (PC) at least 95% of the day in which a sitting/stationary position is required. While performing the duties of this job, the employee is regularly required to talk or hear. Is subject to work standards and must achieve and maintain a commendable performance level in production and quality with minimal supervision. Must be able to adhere to a very strict schedule to include varying start and stop times and when allowed to go to break/lunch.
- High school education or its equivalent required. College or continuing education courses in communications, interpersonal relationships, psychology, anatomy, physiology, medical terminology, composition or business letter writing is preferred.
- Working knowledge of Blue Cross and Blue Shield of Kansas customer service systems is required upon completion of training.
- Detailed knowledge of contracts, benefit coding, enrollment regulations, and legal issues such as HIPAA, COBRA, OBRA, and MSP are required upon completion of training.
- Excellent customer service skills, problem solving skills and organizational skills are required.
- Must be comfortable working individually in a structured environment.
- Proficiency in Grammar, Spelling, Typing and Basic Math are required.
- Two year’s experience navigating multiple computer systems preferred.
- Two year’s customer service experience preferred.
- Excellent human relations and communication skills are required with the ability to interact positively with external customers and all levels of internal staff
Customer Service Representative – Remote Jobs – Lawrence, KS, USA – Prodigy