Customer Service Representative I

Customer Care Representative

Location: Avera Health Broadband Lane

Worker Type: Regular

Work Shift: Day/Evening/Weekend/Holiday Shift (United States of America)

Pay Range: $20.50 - $27.00

Position Highlights

You Belong at Avera

Be part of a multidisciplinary team built with compassion and the goal of Moving Health Forward for you and our patients. Work where you matter.

A Brief Overview

Responsible for providing exceptional service to members and providers of the Avera Insurance Division. The Customer Care Representative will provide customer service to members, providers, groups, and staff by providing accurate and timely responses to inquiries regarding eligibility, claims, benefits and appeal rights.

What You Will Do

Operates a multi-line telephone system in a professional and timely manner along with multiple software programs to resolve member, providers, payers, and groups inquiries.

Answer questions, investigate issues, and solve problems in an efficient and responsive manner. Customer care is provided via web solutions, in person consultation, and telephone.

Provide accurate and consistent communication of policy and procedures to members and providers.

Facilitate member eligibility, entry and termination processes for delegate vendors.

Provide support for other departments with questions, mailings, proofing, and call coverage.

Determine benefit levels for members assigned by policy for specific handling.

Evaluate if claims need to be reprocessed and complete necessary documentation to request an adjustment or refund.

Provide input to customer care leadership regarding ways to perform the position functions more effectively.

Consistently document and report all calls and issues initiated and/or addressed within the customer care department.

Essential Qualifications

The individual must be able to work the hours specified. To perform this job successfully, an individual must be able to perform each essential job function satisfactorily including having visual acuity adequate to perform position duties and the ability to communicate effectively with others, hear, understand and distinguish speech and other sounds. These requirements and those listed above are representative of the knowledge, skills, and abilities required to perform the essential job functions. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential job functions, as long as the accommodations do not cause undue hardship to the employer.

Required Education, License/Certification, or Work Experience:

High School or GED Equivalent

Preferred Education, License/Certification, or Work Experience:

1-3 years related experience

Expectations and Standards

Commitment to the daily application of Avera's mission, vision, core values, and social principles to serve patients, their families, and our community.

Promote Avera's values of compassion, hospitality, and stewardship.

Uphold Avera's standards of Communication, Attitude, Responsiveness, and Engagement (CARE) with enthusiasm and sincerity.

Maintain confidentiality.

Work effectively in a team environment, coordinating work flow with other team members and ensuring a productive and efficient environment.

Comply with safety principles, laws, regulations, and standards associated with, but not limited to, CMS, The Joint Commission, DHHS, and OSHA if applicable.

Benefits You Need & Then Some

Avera is proud to offer a wide range of benefits to qualifying part-time and full-time employees. We support you with opportunities to help live balanced, healthy lives. Benefits are designed to meet needs of today and into the future.

PTO available day 1 for eligible hires.

Up to 5% employer matching contribution for retirement

Career development guided by hands-on training and mentorship

Avera is an Equal Opportunity Employer - Qualified applicants will receive consideration for employment without regard to race, color, religion, sex, national origin, disability, Veteran Status, or other categories protected by law. If you are an individual with a disability and would like to request an accommodation for help with your online application, please call 1-605-504-4444 or send an email to talent@avera.org.

At Avera, the way you are treated as an employee translates into the compassionate care you deliver to patients and team members. Because we consider health care a ministry, you can live out your faith, uphold the dignity and respect of all persons while not compromising high-quality services. Join us in making a positive impact on moving health forward.

The policy of Avera to provide opportunities for all qualified employees or applicants without regard to disability and to provide reasonable accommodations for all employees or applicants who may be disabled. Avera is committed to ensuring compliance in accordance with the Americans with Disability Act. For assistance, please contact HR Now at 605-504-4444.

Additional Notices:

For TTY, dial 711

Avera is an Equal Opportunity/Affirmative Action Employer: Minority/Female/Disabled/Veteran/Sexual Orientation/Gender Identity.