Customer Service Representative I (LBS)

About the Role

The Customer Service Representative resolves customer inquiries via telephone, fax, off-phone work, and email concerning account benefits, claim payments, and enrollment in accordance with Operational Risk Audit (ORA), HIPAA, and other legislative requirements. This role requires participation in training immediately upon hire to become proficient in one line of business to independently perform the duties outlined. Training in a second line of business must be initiated and completed within 12 months of proficiency in the first line of business to cross-functionally support the department. The initial line of business will be determined by the area of greatest need at the time of hire.

Key Responsibilities

• Researches, documents, interprets, and responds to inquiries from internal and external customers, business partners, and special groups concerning products, services, and policies in accordance with ORA, HIPAA, and other legislative requirements.
• Researches and responds to questions related to claims, onboarding, effectuation, retention, provider inquiries, and any other complex inquiry.
• Identifies and follows through on issues impacting the Health Plan and customer experience.
• Provides service to customers and business partners while responding in a professional, efficient, and timely manner to enhance member and provider satisfaction and retention.
• Exercises tact, patience, and professionalism at all times in responding to internal/external customers.
• Utilizes appropriate resources to resolve customer inquiries accurately & efficiently, resulting in acceptable quality, First Call Resolution, and performance.
• Develops effective internal working relationships for improved communication and collaboration.
• Shares ideas and solutions to improve processes, procedures, and systems.
• Participates in meetings, training, and skill development.
• Consistently demonstrates high standards of integrity by supporting the Lifetime Healthcare Companies’ mission and values, adhering to the Corporate Code of Conduct, and leading to the Lifetime Way values and beliefs.
• Maintains high regard for member privacy in accordance with corporate privacy policies and procedures.
• Regular and reliable attendance is expected and required.
• Performs other functions as assigned by management.

Requirements & Tech Stack

• High School diploma or equivalent.
• Strong communication skills across multiple channels including, but not limited to, voicemail, email, outbound calls.
• Adept at communicating effectively and diplomatically while working as a collaborative team member.
• Strong organizational skills and ability to prioritize, work in a fast-paced environment, and remain professional and focused under multiple pressures and demands.
• Ability to efficiently resolve customer concerns by actively listening, navigating screens on the computer, typing call documentation, and speaking to the customer simultaneously.
• Excellent computer skills required, including the ability to navigate in a Windows environment.
• Skillful at working between multiple programs and applications at the same time.
• Proven reasoning and problem-solving skills.
• Ability to work occasional overtime as required to meet business needs.
• Ability to work while sitting and/or standing at a workstation viewing a computer and using a keyboard, mouse and/or phone for three (3) or more hours at a time.
• Ability to hear, understand, and speak clearly while using a phone, with or without a headset.
• Ability to arrive at work on time and as scheduled.
• Ability to meet minimum performance metrics.

Qualifications

• Customer service experience preferred.