Job Summary Provides quality customer service by applying SCAN Five Service Principles Educates members, family, providers and caregivers regarding benefits and plan options.
- Accurately explains benefits and plan options in person, via email or telephonically.
Provides follow-up with members by clarifying the customer's issue, determining the cause, and identifying and explaining the solution. Escalates appropriate member issues to management or other departments as required.- Consistently meets and/or exceeds the departmental standards, including, but not limited to quality, productivity, and adherence to schedule and attendance.
Responds appropriately and in a timely fashion to member/internal staff/providers by answering telephonic and written inquiries concerning benefits, eligibility, referrals, claims and all other issues following departmental policies and procedures and job aids. Takes ownership of the issue, focusing on providing solutions and options for members, as necessary through resolution of member issue.
Increases member satisfaction by following up and resolving member issues, complaints, and questions in an efficient, timely and accurate fashion; coordinates resolution with providers and other departments as needed.
- Participates in member calling projects as assigned by management to support the overall SCAN goal of membership retention.
Follows policies and procedures and job aids in order to maintain efficient and complaint operations; communicates suggestions for improvement and efficiencies to management; identifies and reports problems with workflows following proper departmental procedures; actively participates in departmental staff meetings and training sessions.Follows all appropriate Federal and State regulatory requirements and guidelines applicable to SCAN Group operations, as documented I company policies and procedures. Follows all HIPAA requirements.- Documents transactions by completing applicable member forms and summarizing actions taken in appropriate computer system and following standards set by the department or by other authorized individuals. Responds to routine member questions and concerns on specific medical group call queues as part of skill development.
Education- High School Graduate or equivalent degree - Experience/Skills/Requirements-
1-2 years of call center or related customer service experience, required.
- 1-2 years of prior experience with Medicare benefits, including Medicare Advantage Plans preferred. Experience in the healthcare, insurance or pharmacy industry is highly desirable.
Ability to always maintain a calm demeanor, including during highly charged situations Data entry and general computer skills (word processing, e-mail) are required.- Effective communication (oral and written) skills. A professional/pleasant telephone manner is required.
Ability to handle large call volume, while providing excellent customer service at all times required.
- Demonstrated efficiency/effectiveness in an environment with a high call volume. Language proficiency in English and skilled language must be at business level fluency.
Job Type: Full-time
