Customer Service Representative - Coastal TPA

Customer Service Representative I

The Customer Service Representative I will handle incoming calls from health plan members and healthcare providers, assisting with inquiries related to eligibility, claims status, and benefits. This role is crucial in supporting our members, so the ideal candidate should have a genuine desire to help others and demonstrate empathy in every interaction. We're looking for a curious, solution-oriented problem solver who can balance compassion with professionalism in a fast-paced environment.

Responsibilities

• Interacts with customers (client, member and provider) via telephone, email, or in person to provide support and information specific to eligibility, benefits, claims, prior authorization requirements and appeals.
• Document all communication in the applicable system of record.
• Provide proactive education to customers, as it relates to their specific inquiry.
• Provide accurate and timely responses to all customer inquiries.
• Successfully bring all issues to closure within appropriate timeframe.
• Provide support and coverage to inter-departmental staff as needed.
• Coordinate customer appeals and grievances with appropriate staff.
• Perform other activities and functions as assigned.

Position Requirements

• Excellent verbal and written communication skills, including active listening.
• Minimum three years' experience in customer service, call center, or similar.
• Service-oriented; Ability to resolve customer complaints and issues while maintaining a professional and calm demeanor.

• Ability to operate spreadsheet, word processing programs and computer equipment required to fulfill position responsibilities.

• Exceptional diplomacy skills to effectively resolve issues under sometimes tense and stressful circumstances.
• Excellent phone manner
• Ability to use sound judgement, identify next steps to be taken, and develop appropriate solutions.
• Bilingual Spanish/English desired.

Competencies

• Accountability and Dependability: Assumes responsibility for completing duties in an effective and timely manner.
• Integrity: Consistently honors commitments and takes responsibility for actions and words.
• Software and Computer Skills: Proficient in the use of Microsoft Office Suite, Highly skilled at using the Internet. Must learn effectively with computer-based and/or online training.
• Flexibility: Demonstrates adaptability and openness to alternative solutions and flexibility when interacting with others, understanding their attitudes, needs, interests, and perspectives.
• Inclusiveness: The ability to network and partner with all internal and external stakeholders including broad and diverse representation of private/public and traditional/non-traditional community organizations.

Skills and Education

• Associates degree, or applicable professional experience, required.
• Minimum 1 to 3 years experience in a customer service, hospitality, or call center.

Competitive benefit package

Pay rate: $23.00 an hour

Aspire Health Plan is an equal opportunity employer.

Assigned Work Hours: Full time, 8:30am - 5:00 pm

Position Type: Regular