Customer Service Representative (Work at Home)

Virtual Staffing Solutions

Skills

Works with members, providers, and staff to identify and resolve member service and retention related issues.
Educates potential members/community representatives on plan features, plan benefits, and program admission requirements.
Ensures first call resolution, maintaining in-depth expertise and knowledge of the organization structure, departmental tasks and vendor responsibilities to triage needs effectively.
Coordinates telephonic intake and responses to both clinical and non-clinical customer service issues.
Identifies nature of issue, independently responds to and resolves non-clinical issues and complaints, and escalates clinical issues to appropriate departments and staff.
Documents accurate and comprehensive call details, actions taken, and education provided across all separate and dependent interdepartmental systems, ensuring reporting accuracy and compliance.
Enters and reconciles data, processes service requests, and follows up to ensure timely scheduling and delivery of services.
Provides education on benefit coverage, service expectations, and the status or appeals process for requested services to achieve member satisfaction.
Maintains expertise in Health Plans, Home Care, Hospice and Personal Care benefits, network and organization structure.
Acts as a resource to consumers and providers to guide them in accessing and understanding their benefits.

At least 1 year of customer service experience, preferably in a healthcare, health plan, or related environment.
Strong verbal communication, active listening, and customer service skills with the ability to build rapport and resolve concerns effectively.
Military Spouse Employment Partnership (MSEP) candidates are encouraged to apply and will be given priority consideration.
Company-issued PC provided; candidates must have a dedicated, professional workspace for remote work.