Cust Service Rep Job Description

Job Description Job Title: FLSA Status: Job Class: Reports to: Department: Location: Customer Service Representative Non-Exempt 3 Operations Supervisor/Manager TPA Operations Amherst JOB SUMMARY Under routine supervision, the Customer Services Representative is responsible for handling all incoming telephone calls from Participant, Employers, Providers, and brokers/agents regarding their health insurance policy. The focus of this position centers around the careful, deliberate, imaginative and serious undertaking of defined work. ESSENTIAL DUTIES        Handle all incoming calls regarding the Participant’s policy (enrollment issues, claims issues, provider questions, benefits, etc.). Investigate and resolve outstanding issues on behalf of the Participant by communicating with applicable departments and responding to the Participant. Ability to educate Participant on their plan guidelines, policies and procedures. Initiate claim adjustments, additional ID card replacements, duplicate EOB’s, canceled check requests, etc. Enter appropriate calls into MACESS. Respond to any applicable written requests from Participant. All other duties as deemed essential to the job function. SECONDARY DUTIES       Analyze and process claims Investigate problem claims Follow up with pended claims Pull claims for auditing Maintain daily paid claims workload File as needed REQUIRED KNOWLEDGE, SKILLS, AND ABILITIES    Ability to deal in a systematic and patient way with factual and technical information and processes, as well as an ability to focus directly on the knowledge base required for the task. This job requires a serious and disciplined approach. Ability to work independently Strong attention to quality Job Description Job Title: FLSA Status: Job Class: Reports to: Department: Location:            Customer Service Representative Non-Exempt 3 Operations Supervisor/Manager TPA Operations Amherst Strong follow-up skills Ability to read and understand various materials, files, documentation and other information within the department Ability to communicate with a variety of audiences Basic mathematical skills to verify the accuracy of clerical documents Excellent customer service skills Knowledge of PC applications (windows based programs) Ability to receive and handle phone calls, responding to inquiries, handling complaints Attention to detail Flexibility Strong verbal and written communication skills Organizational, technical and interpersonal skills QUALIFICATION STANDARDS High school diploma or any combination of education, experience, and training that provides the knowledge, skills, and abilities to perform the duties of the position. Knowledge of the healthcare industry is a plus. PREFERRED QUALIFICATIONS College degree and extensive customer service skills Note: Management reserves the right to change or reassign job duties or combine positions at any time. Last Revised: May 22, 2007 Human Resources: Department Manager: Date: Date: