Customer Service Representative

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POST DATE 9/12/2016
END DATE 10/24/2016

AppleOne Rancho Cordova, CA

Rancho Cordova, CA
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Full Time
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Customer Service Representative

Job Summary:

The Customer Service Representative is responsible for receiving, answering, and/or resolving phone calls from insured?s and their dependents, providers and their staff, employer/group staff, and brokers. The Customer Service Representative will inquire on the status of claims, ID cards, addresses, and other issues as queried by the caller. The Customer Service Representative is also the primary source for issuing authorizations when eligible for services.

Duties and Accountabilities:

?Provide timely and accurate information to basic incoming customer calls from members, providers, and other external and internal constituents including issuing authorizations, handling claim inquiries from providers and members, communicate the correct information regarding accessibility, claims status and other calls of a service nature, and providing benefits information.
?Process customer claims according to established department policies and procedures.
?Handle customer/provider requests for I.D. cards, authorizations, customer service questions and issues.
?Fulfill rapid call volume by handling the appropriate amount of calls coming into the call center daily.
?Complete Provider Relations requests for service.
?Provide timely feedback to the company regarding customer service failures and/or customer/provider concerns.
?Partner with Sales and Provider Relations to meet and exceed customer?s service expectations.
?Provide excellent customer service and handle all customers in a professional and courteous manner. Perform other related duties as assigned.

Education: High school graduate or equivalent is mandatory.
Experience:One to two years experience in a managed health care or insurance environment preferred. One to two years customer service or call center experience. Strong computer and technical skills to support heavy key data entry.


?Excellent interpersonal verbal and written communication skills.
?Communications skills including the ability to diffuse volatile situations, share information, and educate callers regardless of level of understanding.
?Understanding of managed care or insurance industries.
?Strong execution and follow-up skills.
?Goal oriented with ability to meet production standards.
?Team orientation and ability to work effectively across functional areas of the company.
?Well Organized and Resourceful.
?Accurate and efficient data entry skills.
?Strong analytical skill and ability to demonstrate good judgment.
?Ability to work independently with moderate supervision.
?Ability to coordinate multiple tasks and projects.
?Excellent customer service skills (friendly, courteous and helpful).
?Skilled in dealing with all customers in an efficient and effective manner.
?Spanish Bilingual skill helpful.
We are an equal employment opportunity employer and will consider all qualified candidates without regard to disability or protected veteran status.

Job Experience:

One year of call center and customer service experience, reliable, MS Office