Customer Service Specialist (hybrid - Troy, MI) - Health Alliance Plan

Business (Non-Clinical)

This position has the following primary objectives with respect to customer relations for all HAP product lines:

Provide follow-up and courteous and prompt resolution to internal and external customer inquiries by conducting thorough investigations and fully educating customers.

Support corporate and departmental goals, member enrollment activities and product implementations.

Research, investigate and resolve service failures. Improve the customer experience by identifying root causes, trends and recommend resolutions for service recovery and retention.

Educate internal and external customers and prospective members to promote HAP as the health care coverage of choice.

Principal Duties and Responsibilities:

• Respond to inquiries by telephone (inbound and outbound), mail and in person; research and answer inquiries, complaints and appeals by following all department standards, policies and procedures; direct inquiries to supporting departments for appropriate action and resolution.
• Educate internal and external customers and potential members on policies, procedures, product offerings, benefit plan and coverage provisions related to all HAP products.
• Document all incoming inquiries accurately to track member inquiry history and trends.
• Practice and maintain confidentiality to Privacy and HIPAA regulations. Proactively seek training and development to enhance skills and abilities.
• Monitor workflow inbox and outstanding cases to ensure that all inquiries receive an appropriate response in a timely manner; Contact internal/external customers (by phone/or in writing), as needed, to ensure timely resolution and follow-up to inquiry.
• Interact with support departments in a professional manner to ensure internal and external customer needs are met. Develop and maintain strong business relationships with inter-departments; Continue to self-educate on changes in policies and procedures that occur in other departments which could have an impact on department operations and the servicing of customers.
• Attend training and development sessions or continuing education opportunities offered by Customer Service and maintain enhanced skill levels and performance.
• Interact with providers and their staff to obtain information for resolving customer inquiries/complaints.
• Ensure and maintain compliance of all department and corporate standards, policies and procedures.
• Recommend process improvements based on observations and trends identified while interacting with internal and external customers.
• Coordinate and assist with various departmental projects, member enrollment periods, outreach activities and corporate initiatives.

Education/Experience Required:

• Associate degree or a minimum of four (4) years of recent and related work experience in a customer service capacity may be considered in lieu of the degree.
• Course in Medical Terminology (required completion within six months of post-employment.)
• Minimum of two (2) years of recent Customer Service or Call Center experience.

Skills and Abilities:

• Must be dependable.
• Demonstrate a high degree of integrity, patience, maturity, empathy, tact and diplomacy.
• Demonstrate problem solving skills, flexibility, good judgment and ability to provide service excellence.
• Demonstrate the ability to handle assigned projects from start to successful completion including appropriate follow-up and documentation.
• Demonstrate the ability to handle multiple priorities concurrently in a timely and accurate manner.
• Demonstrate strong interpersonal, listening, verbal communication and business writing skills.
• Demonstrate efficiency in using a PC and various Microsoft programs.
• Fundamental understanding of HMO/PPO/POS delivery system and claims billing.
• Must be able to work flexible shifts, overtime including evenings and weekends as requested and/or scheduled.