Senior Customer Service Rep

Job Summary

Assist and educate members employer groups providers colleagues and/or Elite agents of health plan benefits with accessing services facilitating and resolving complex problems understanding claims billing and coding along with other non-routine questions. Consistently serve as a go-to person for others while creating an exceptional experience with each contact via inbound and outbound calls face-to-face interactions online chat email etc.

Essential Functions

• Demonstrates high competency in analyzing evaluating and responding to complex service inquires from members providers employer groups colleagues agents Elite agents and different customer types across multiple Priority Health products within departmental guidelines. Regularly serve as subject matter expert ensuring professional and pleasant interactions at all times.

• Partnering with internal and external resources promptly provides customers with information and education concerning benefit clarification eligibility requirements verification authorization billing and claim status. Identifies potential trends or issues that impact health plan members and works with coworkers and leadership resources to suggest process improvements.

• Promptly identifies and resolves or escalates customer concerns or complaints to achieve positive outcomes. Places outbound welcome calls to members to educate them on their benefits as needed. Assists walk-in members and agents if assigned by leadership.

• Adheres to established procedure and quality guidelines in support of Priority Health service promise key drivers performance indicators as well as Corporate values and codes of excellence. Serves as a role model of exceptional customer service and assists with providing Best Practice benchmarks in procedures.

• Assists customers with administrative issues such as submitting enrollment record changes providing letter explaining coverage or benefits and obtaining and relaying certain member information to other departments as needed.

• Facilitates claims resolution through follow-up on member calls and correspondence received to appropriate departments.

• Effectively tracks and/or documents all service interactions with customers within appropriate systems within guidelines. Also provides direct subject matter expertise to peers and the leadership team through participation in Resource Line mentoring of newly skilled employees and committees as assigned.

• Develops and maintains behaviors of productivity availability to customers and adherence to work schedule.

How Corewell Health cares for you

• Comprehensive benefits package to meet your financial health and work/life balance goals. Learn more here.

• On-demand pay program powered by Payactiv

• Discounts directory with deals on the things that matter to you like restaurants phone plans travel and more!

• Optional identity theft protection home and auto insurance and pet insurance

• Traditional and Roth retirement options with service contribution and match savings

Qualifications

Required

• Required High School Diploma or equivalent

• Preferred Associates Degree

• 5 years of relevant experience in customer-facing service on phone or face-to-face focus on positive customer outcomes; customer service and/or managed health care Required

About Corewell Health

As a team member at Corewell Health you will play an essential role in delivering personalized health care to our patients members and our communities. We are committed to cultivating and investing in YOU. Our top-notch teams are comprised of collaborators leaders and innovators that continue to build on one shared mission statement - to improve health instill humanity and inspire hope. Join a nationally recognized health system with an ambitious vision of continued advancement and excellence.

How Corewell Health cares for you

• Comprehensive benefits package to meet your financial health and work/life balance goals. Learn more here.

• On-demand pay program powered by Payactiv

• Discounts directory with deals on the things that matter to you like restaurants phone plans spas and more!

• Optional identity theft protection home and auto insurance pet insurance

• Traditional and Roth retirement options with service contribution and match savings

• Eligibility for benefits is determined by employment type and status

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CURRENT COREWELL HEALTH TEAM MEMBERS Please apply through Find Jobs from your Workday team member account. This career site is for Non-Corewell Health team members only.

Corewell Health is committed to providing a safe environment for our team members patients visitors and community. We require a drug-free workplace and require team members to comply with the MMR Varicella Tdap and Influenza vaccine requirement if in an on-site or hybrid workplace category. We are committed to supporting prospective team members who require reasonable accommodations to participate in the job application process to perform the essential functions of a job or to enjoy equal benefits and privileges of employment due to a disability pregnancy or sincerely held religious belief.

Corewell Health grants equal employment opportunity to all qualified persons without regard to race color national origin sex disability age religion genetic information marital status height weight gender pregnancy sexual orientation gender identity or expression veteran status or any other legally protected category.

An interconnected collaborative culture where all are encouraged to bring their whole selves to work is vital to the health of our organization. As a health system we advocate for equity as we care for our patients our communities and each other. From workshops that develop cultural intelligence to our inclusion resource groups for people to find community and empowerment at work we are dedicated to ongoing resources that advance our values of diversity equity and inclusion in all that we do. We invite those that share in our commitment to join our team.

You may request assistance in completing the application process by calling 616.486.7447.