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Under the direct supervision of the operations supervisor, the customer service representative is responsible for responding to a diverse membership and their providers, as well as other customers, in a timely, professional, and courteous manner. This includes inbound and outbound member and/or provider phone calls or correspondence regarding benefits, eligibility, or customer issues. Makes outreach welcome calls to new members and conducts Health Risk Assessment Surveys as needed. Provides member education and assists members with PCP selection and assignments. Assists with access to care and wellness program. Follows internal processes and procedures to ensure all activities are performed in accordance with departmental and company policies and procedures.
Demonstrate a passion for providing superior customer service to our customers and continually seek to understand the needs of those we serve. Create accurate and timely member documentation concerning all inquiries taken in accordance with established protocols to ensure resolution is provided and presented clearly and accurately. Present and project a positive image of the company in and out of the office to fellow associates, members, providers, and the community by being courteous, helpful, energetic, respectful, and polite. Strive to resolve an inquiry on first contact while ensuring that the inquiry has been addressed to the customer's satisfaction by using all resources efficiently and timely. Provide feedback and/or solutions to the supervisor to ensure continuous process improvement and a better customer experience. Creates and supports an environment that fosters teamwork, cooperation, respect, and diversity. Maintain an awareness of all product knowledge information. Able to respond positively to support change within the department and the company. Willing to be flexible regarding job responsibilities and schedule, not limited to but including overtime and holidays, as a result of contractual business requirements. Routinely meet or exceed contact center key performance indicators. Perform other duties as assigned.
Schedule & Training Information
Education/Experience: 1 year prior customer service experience required. Call center experience taking in-bound and/or out-bound calls preferred but not required. Prior experience in the healthcare or managed care industry is preferred but not required. High School diploma or GED required. Minimum 45 wpm typing skill preferred. Excellent judgment and decision-making skills in dealing with complaints and sensitive requests required. Ability to use PC applications in an MS Windows-based environment. Must be in the Eastern Standard Time zone.
Our Comprehensive Benefits Package
Flexible work solutions include remote options, hybrid work schedules, competitive pay, paid time off, holidays and volunteer events, health insurance coverage for you and your dependents starting Day 1, 401(k) retirement savings plan, tuition reimbursement, and more.
Why Join Us: Your career starts now. We are looking for the next generation of healthcare leaders. At AmeriHealth Caritas, we are passionate about helping people get care, stay well, and build healthy communities. As one of the nation's leaders in healthcare solutions, we offer our associates the opportunity to impact the lives of millions of people through our national footprint of products, services, and award-winning programs. AmeriHealth Caritas is seeking talented, passionate individuals to join our team. Together, we can build healthier communities.
About AmeriHealth Caritas
Headquartered in Newtown Square, Pennsylvania, AmeriHealth Caritas is a mission-driven organization with over 30 years of experience. We deliver comprehensive, outcomes-driven care to those who need it most. Our services include integrated managed care products, pharmaceutical benefit management and specialty pharmacy services, behavioral health services, and other administrative services.