Call Center Representative II

Call Center Representative II

Position Summary:

The Call Center Representative, Level 2 will work as part of a team to ensure that the quality of customer service provided to our customers meets or exceeds the highest standards for the organization. This includes measurements of accuracy of information provided, consistency in documentation of each request, and will assure that appropriate general, claim, and grievance inquiry codes are documented. The MedCost Benefit Services (MBS) CCR II will service and resolve the customer inquiries related to claims, eligibility, and benefit plans administered by MBS.

Position Responsibilities:
• Provide service and resolution when applicable at the levels defined for customer service representatives. Log each inquiry into the call tracking system and document the call type, referral code and all narrative documentation to support the call. If necessary, determine the need for resolution within the appropriate referral channels and send request for additional action steps. Make necessary outbound calls to correct issues or facilitate resolution for customer.
• Stay abreast of resource information to ensure appropriate information is being provided. This includes, but is not limited to training manual, plan documents, on-line reference tables, claims system, reference materials and schedules of benefits.
• Coordinate resolution of open issues from incoming inquiries assigned either through management of open issues log, or through call backs requested from voice mail.
• Participate in weekly staff meetings related to skill enhancement and informational purposes.
• Effective queue management based on defined adherence goals, and/or staffing issues necessitating awareness.
• The capability to service and train others on both MBS and PPO calls.
• The capability to service & train others on incoming email/web referrals, and our web chat platform.

Please note this job description is not designed to cover or contain a comprehensive listing of activities, duties or responsibilities that are required of the employee for this job. Duties, responsibilities, and activities may change at any time with or without notice.

Position Qualifications:

Required
• High school diploma or equivalent required.
• Typing proficiency score of 35 words per minute or higher.

Skills, Knowledge, and Abilities
• Knowledge of the health care industry, call center queue environment, and claims payment processes.
• Excellent oral and written communication skills
• Exceptional customer service, and interpersonal skills
• Effective problem-solving skills
• Strong organizational, self-motivation, and decision-making skills
• Proficiency using Microsoft programs (Word, Excel, PowerPoint)
• Ability to manage multiple priorities in a fast-paced environment
• Ability to work independently and collaboratively, as needed

MedCost provides equal employment opportunities to all employees and applicants for employment and prohibits discrimination and harassment of any type without regard to race, color, religion, age, sex, national origin, disability status, genetics, protected veteran status, sexual orientation, gender identity or expression, or any other characteristic protected by federal, state or local laws. This policy applies to all terms and conditions of employment, including recruiting, hiring, placement, promotion, termination, layoff, recall, transfer, leaves of absence, compensation and training.

MedCost participates in the Electronic Verification system (E-Verify) to electronically verify the work authorization of newly-hired employees. E-Verify is an internet-based program that compares information from an employee’s Form I-9 to data contained in the federal records of the Social Security Administration and the Department of Homeland Security to confirm employment eligibility. MedCost does not use E-Verify to pre-screen job applicants.