Senior Call Center Representative
Senior Call Center Representative
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Job Description
We are searching for a Senior Call Center Representative someone who works well in a fast-paced setting. In this position you will serve as a member and/or provider advocate that understands the organizations processes policies and procedures to investigate resolve and/or facilitate the resolution of simple to complex issues/questions. You will be the first point of contact for assistance or information regarding eligibility benefits authorizations claims referrals and/or any other member/provider demands. Lastly you will assist and advocate for members and/or providers throughout the complaint and appeal process and support members with timely appointment scheduling.
Think youve got what it takes
Job Duties & Responsibilities
Act as a secondary resource to Call Center Representatives in the absence of the Team Lead and responds to escalated calls and triages to management if necessary
Identify and handle a variety of routine to complex customer or prospect inquiries or requests
Educate members about their health coverage benefits and services and empowering members/providers by directing them toward available resources for self-help
Meet Senior Member Service Representative performance goals for customer satisfaction quality productivity and all performance metrics
Ensure all HIPAA and state privacy and confidentiality requirements/regulations are adhered to at all times
File complaints and appeals on behalf of members and providers within the regulatory timeframe and in compliance with departmental policies and procedures
Skills & Requirements
High school diploma or GED
Minimum of 3 years of customer service call center and/or experience within managed care or insurance industry or
A Bachelors degree may substitute for two (2) years of the required experience
Required Experience:
Senior IC
Employment Type
Full-Time
