Job Description

Customer Service Representative (Remote)

Are you an experienced Customer Service Representative looking for a new challenge?

Do you value customer service and helping your community?

Are you motivated, energetic, and excited to become part of the team?

If so, you might be our next new team member!

Perk Of This Role

Fully remote position, where you can work from home. Rotational shifts available for EST, CT or PST.

Full benefits (medical, dental, vision, etc.) effective the first month following your hire date!

Paid time off for great work life balance

401k with match with no vesting period

Join us to build upon your experience and to advance your career, while doing meaningful work that will help vulnerable populations get the healthcare they need.

Join our team to do work you can feel good about everyday!

Who We Need

A Customer Service Representative to provide all customer service support for the Review Team including but not limited to the following activities: Interacting with beneficiaries and providers via the helpline, creation, formatting and proofreading of letters as well as maintaining timeliness. This position requires a great deal of decision making in regard to more different types of complex appeals.

Why us?

We are a rapidly growing national quality improvement and care management organization. We work to ensure that over 20 million people receive the right care, at the right time, in the right setting.

People Focused. Mission Driven.

Shape the future of healthcare with us. We are mission driven to improve lives through healthcare quality and clinical expertise.

We do this through our people.

You can do meaningful work that makes a real difference for the lives of individuals across the country. We are an organization that cares deeply about our employees and we provide the training and support to do the best work of your career.

Benefits are a key component of your rewards package. These benefits are designed to provide you and your family additional protection, security, and support for both your career and your life away from work. They are comprehensive and fit a variety of needs and situations. Our benefits include comprehensive health plans, paid time off, retirement savings, corporate wellness, educational assistance, corporate discounts and more.

RESPONSIBILITIES

Responsible for typing/merging, proofing for clarity, printing, and mailing correspondence.

Communicate verbally and in writing with external customers to furnish and request review information.

Foster effective working relationships between our internal and external customers.

Assist with and participate in Review Team in identifying areas for potential improvement, as noted on case reviews and process.

Answers the Beneficiary Helpline through the utilization of the hunt group and available light functions. 

Determines how to best assist caller either by a service offered or by referring them to an external agency and properly enter referral into CMS system.

All letters sent out in timely manner with correct components included and reviewed for grammatical and spacing errors.

Get and validate notices and all components of medical records.

Provide intake for all appeals received.

Proficient in customer service guidelines and standards.

Utilize internal quality control tools to assess individual work and team processes.

QUALIFICATIONS

High school diploma or equivalent.

Post high school business courses helpful.

Medical terminology desired.

Excellent verbal communication skills, courteous and patient demeanor, must be customer oriented and have the ability to maintain composure under potentially stressful situations.

Good grammar, punctuation, spelling, hyphenation, and written communications skills.

Customer focused, results oriented and capable of building and maintaining relationships with internal and external customers. Must be flexible and able to work as a team member and support team decisions.

General knowledge of a PC based computer system desirable. Knowledge of various software packages with ability to learn additional software packages as needed.

Must be able to multi-task and to prioritize assignments.

Must have good organizational skills and be able to work independently.

EXPERIENCE

Two to three years clerical experience including word processing, various filing systems, and telephone customer service responsibilities.

Prior work in a healthcare setting or medical terminology recommended. Previous data entry or other clerical experience is a plus.

Thank You!

We know your time is valuable and we thank you in advance for applying for this position. Due to the high volume of applicants we receive, only those who are chosen to advance in our interview process will be contacted. We sincerely appreciate your interest and invite you to apply to future openings that may be of interest. Best of luck in your search!

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