To respond to inbound verbal inquiries, complaints, and compliments identified by members, providers and other external customers. Responsible for conducting research, providing education, and interfacing with internal and external entities to resolve issues of concern, to provide service recovery whenever possible, and to process requests To ensure the ongoing provision of quality in a customer-focused environment designed to meet or exceed member expectations for advocacy, service, and education, accomplished in an effective, efficient and compassionate manner.
Essential Functions:
Answer, research and resolve inbound calls from members, providers and other external customers, documenting each contact accurately per established departmental requirements
Maintain a thorough and current comprehension of all aspects of the following systems: Common Membership, BETS, Access, Diamond, PIMS, KP Health Connect, Lumina, EMI, Texas Imax, KANA, Image Repository, Lexica, Lotus Notes, Microsoft Word & excel spreadsheet
Ensure each call coded and documented correctly, per established departmental requirements, this responsibility is critical, as it feeds the databases used to report satisfaction statistics regionally, enterprise-wide and to our regulatory and accrediting agencies. Further, senior quality council to identify trends, and recommend improvements for deployment in all areas where member s issues identified and data used, complete, concise and accurate documentation is further critical to maintaining an accurate history of member interactions with the Plan
Ensure that national standards pertaining to telephone quality achieved and maintained in compliance with established goals for target and stretch in this critical area of performance
Qualifications Basic Qualifications:
Minimum of three years of customer service experience in the healthcare industry
Combination of education and experience normally represented by an associate s degree in business or its equivalent
Computer literacy with proficiency in Microsoft Word and Excel applications
Ability to type a minimum of 40 wpm as verified by typing test
Ability to pass a grammar assessment
Must be detail oriented with a high degree of accuracy
Exceptional listening and communication skills required
Exceptional time management self-motivation ability to manage competing priorities excellent organizational and problem-solving skills
Preferred Qualifications:
Associate's degree preferred
Additional coursework in medical terminology is preferred
Primary Location: Ohio-Brooklyn Heights-Member Service Call Center 5500 Lancaster Dr. Scheduled Hours (1-40): 40 Shift: Day Working Days: Mon-Fri Working Hours Start: 8:00am Working Hours End: 5:15pm Schedule: Full-time Job Type: Standard Employee Status: Regular Employee Group: Non-Union Non-Exempt Job Level: Individual Contributor Job: Customer Services Public Department Name: Customer Relations Travel: Yes 5% of the time Job Eligible for Benefits: Yes External hires must pass a background check/drug screen. We are proud to be an equal opportunity/affirmative action employer. |