Customer Service Representative - Bilingual
National Healthcare Solutions, Inc., El Paso, Texas, United States, 79901
Customer Service Representative
As a Customer Service Representative, you will play a pivotal role in ensuring the satisfaction of our customers by responding to their inquiries, resolving issues, and providing information through inbound telephone communication. Your primary responsibility will be to manage incoming customer service calls professionally, ensuring that each customer's needs are addressed effectively and efficiently. Essential Duties And Responsibilities
The essential functions include, but are not limited to the following: Communicate and provide service to preferred providers in order to build positive supporting relationships. Assists members, providers and healthcare providers with benefit inquiries, referral prior authorizations status and eligibility via inbound telephone calls. Research and identify processing inaccuracies in claim payments and route to the appropriate team for claim adjustments. Maintain and submit thorough and organized records of all interactions, inquiries, and resolutions in the customer service email alias. Follows-up on customer issues, researches problems and processes documents necessary to ensure a successful resolution. Stay updated on company policies, procedures, and compliance regulations in the healthcare and insurance industry. Provides clear articulate communication to accurately describe our services to members/providers and collect information. Handles calls and correspondence that are predominantly routine but may require some deviation from standard procedures. Collaborate with other customer service representatives and departments to address complex member issues and improve overall client and member experience. Performs any other duties that may be requested by supervisor or management. Minimum Qualifications (Knowledge, Skills, And Abilities)
High School Diploma or equivalent required. General knowledge of healthcare terminology a plus Hospitality, retail, or experience working with customers highly preferred. Good verbal and written communication skills This position requires a person who has an inherent service orientation, who can remain calm and clearly communicate tactfully, both externally and internally Strong Knowledge of commonly used concepts, practices, and procedures with the insurance field a plus Bilingual in Spanish a big plus! Other Details
Supervisory Responsibilities
None Work Environment
The noise level in the work environment is usually low to moderate. Physical Demands
The physical demands described here are representative of those that must be met by an employee to successfully perform the essential functions of this position. Reasonable accommodations may be made to enable individuals with disabilities to perform the functions. While performing the duties of this position, the employee is regularly required to talk or hear. The employee frequently is required to use hands or fingers, handle or feel objects, tools, or controls. The employee is occasionally required to stand, walk, sit, and reach with hands and arms. The employee must occasionally lift and/or move up to 25 pounds. Specific vision abilities required by this position include close vision, distance vision, and the ability to adjust focus. Travel Requirements
None This job description in no way states or implies that these are the only duties to be performed by the employee(s) incumbent in this position. Employees will be required to follow any other job-related instructions and to perform any other job-related duties requested by any person authorized to give instructions or assignments. All duties and responsibilities are essential functions and requirements and are subject to possible modification to reasonably accommodate individuals with disabilities. To perform this job successfully, the incumbents will possess the skills, aptitudes, and abilities to perform each duty proficiently. Some requirements may exclude individuals who pose a direct threat or significant risk to the health or safety of themselves or others. The requirements listed in this document are the minimum levels of knowledge, skills, or abilities. This document does not create an employment contract, implied or otherwise. The Company complies with employment regulations as they apply to the location of service.
As a Customer Service Representative, you will play a pivotal role in ensuring the satisfaction of our customers by responding to their inquiries, resolving issues, and providing information through inbound telephone communication. Your primary responsibility will be to manage incoming customer service calls professionally, ensuring that each customer's needs are addressed effectively and efficiently. Essential Duties And Responsibilities
The essential functions include, but are not limited to the following: Communicate and provide service to preferred providers in order to build positive supporting relationships. Assists members, providers and healthcare providers with benefit inquiries, referral prior authorizations status and eligibility via inbound telephone calls. Research and identify processing inaccuracies in claim payments and route to the appropriate team for claim adjustments. Maintain and submit thorough and organized records of all interactions, inquiries, and resolutions in the customer service email alias. Follows-up on customer issues, researches problems and processes documents necessary to ensure a successful resolution. Stay updated on company policies, procedures, and compliance regulations in the healthcare and insurance industry. Provides clear articulate communication to accurately describe our services to members/providers and collect information. Handles calls and correspondence that are predominantly routine but may require some deviation from standard procedures. Collaborate with other customer service representatives and departments to address complex member issues and improve overall client and member experience. Performs any other duties that may be requested by supervisor or management. Minimum Qualifications (Knowledge, Skills, And Abilities)
High School Diploma or equivalent required. General knowledge of healthcare terminology a plus Hospitality, retail, or experience working with customers highly preferred. Good verbal and written communication skills This position requires a person who has an inherent service orientation, who can remain calm and clearly communicate tactfully, both externally and internally Strong Knowledge of commonly used concepts, practices, and procedures with the insurance field a plus Bilingual in Spanish a big plus! Other Details
Supervisory Responsibilities
None Work Environment
The noise level in the work environment is usually low to moderate. Physical Demands
The physical demands described here are representative of those that must be met by an employee to successfully perform the essential functions of this position. Reasonable accommodations may be made to enable individuals with disabilities to perform the functions. While performing the duties of this position, the employee is regularly required to talk or hear. The employee frequently is required to use hands or fingers, handle or feel objects, tools, or controls. The employee is occasionally required to stand, walk, sit, and reach with hands and arms. The employee must occasionally lift and/or move up to 25 pounds. Specific vision abilities required by this position include close vision, distance vision, and the ability to adjust focus. Travel Requirements
None This job description in no way states or implies that these are the only duties to be performed by the employee(s) incumbent in this position. Employees will be required to follow any other job-related instructions and to perform any other job-related duties requested by any person authorized to give instructions or assignments. All duties and responsibilities are essential functions and requirements and are subject to possible modification to reasonably accommodate individuals with disabilities. To perform this job successfully, the incumbents will possess the skills, aptitudes, and abilities to perform each duty proficiently. Some requirements may exclude individuals who pose a direct threat or significant risk to the health or safety of themselves or others. The requirements listed in this document are the minimum levels of knowledge, skills, or abilities. This document does not create an employment contract, implied or otherwise. The Company complies with employment regulations as they apply to the location of service.