Customer Service Representative

Job Summary

Inbound call center to assist and educate members, employer groups, providers, colleagues, and/or agents of health plan benefits with accessing services, facilitating and resolving problems, understanding claims, billing and coding, along with other questions. Consistently create an exceptional experience with each contact, via inbound and outbound calls, face-to-face interactions, online chat, email, etc.

Essential Functions

Analyzes, evaluates, resolves and responds to service inquires from members, providers, employer groups, colleagues, agents, Elite agents (customers), and others within departmental guidelines. Professional and pleasant interactions are ongoing expectations.

Partnering with internal and external resources, promptly provides customers with information and education concerning benefit clarification, eligibility requirements, verification, authorization, billing and claim status.

Promptly identifies and resolves or escalates customer concerns or complaints to achieve positive outcomes. Places outbound welcome calls to members to educate them on their benefits as needed. Assists walk-in members and agents if assigned by leadership.

Adheres to established procedure and quality guidelines in support of Priority Health service promise, key drivers, performance indicators, as well as Corporate values and codes of excellence. Identifies potential trends or issues that impact health plan members and works with coworkers and leadership resources to suggest process improvements.

Assists members with administrative issues, such as submitting enrollment record changes, providing letter explaining coverage or benefits, and obtaining and relaying certain member information to other departments as needed.

Facilitates claims resolution through follow-up on member calls and correspondence received to appropriate departments.

Effectively tracks and/or documents all service interactions with customers within appropriate systems according to guidelines.

Develops and maintains behaviors of productivity, availability to customers, and adherence to work schedule.

Qualifications

Required High School Diploma or equivalent

Preferred Associate's Degree

1 year of relevant experience in related field Required

About Corewell Health

As a team member at Corewell Health, you will play an essential role in delivering personalized health care to our patients, members and our communities. We are committed to cultivating and investing in YOU. Our top-notch teams are comprised of collaborators, leaders and innovators that continue to build on one shared mission statement - to improve health, instill humanity and inspire hope. Join a nationally recognized health system with an ambitious vision of continued advancement and excellence.

How Corewell Health cares for you

Comprehensive benefits package to meet your financial, health, and work/life balance goals.

On-demand pay program powered by Payactiv

Discounts directory with deals on the things that matter to you, like restaurants, phone plans, spas, and more!

Optional identity theft protection, home and auto insurance, pet insurance

Traditional and Roth retirement options with service contribution and match savings

Primary Location SITE - Lakeland Hospital St Joseph - 1234 Napier Ave - St Joseph

Department Name PHO Contact Center - Lakeland Care

Employment Type Part time

Shift Day (United States of America)

Weekly Scheduled Hours 24

Hours of Work Variable

Days Worked Variable

Weekend Frequency Every other weekend