Customer Service Representative SHASTA [Redmond Oregon]

Redmond, Oregon
Shasta Administrative Services
Shasta Administrative Services, Redmond, Oregon
Depends on Experience 

Position / Job Title: Customer Service Representative
Location: Shasta Administrative Services in Redmond, Oregon
Major Objective of the Position:
? Answer incoming phone calls and route calls to the appropriate person
? Make outbound calls as needed to resolve member issues
? Log all customer service related calls in the customer service module in a timely manner
? Report all problem calls or extraordinary situations to supervisor or manager
? Route all pre-authorization, case management, and pre-natal care calls to the appropriate queue
? Create issue tickets for provider and member requests related to reconsideration of payment on specific claims
Duties and Responsibilities:
? Assist providers and members with various aspects of client benefit plans
? Assist claim processors with the procurement of documentation and information for payment of claims
? Quote plan benefits and verify eligibility
? Review and report inconsistencies in claim processing and forward for review to the claims department
? Obtain requested or missing information to expedite claim processing
Additional Tasks:
? Perform any other reasonable duties as directed by supervisor or manager
? Assist co-workers and other departments in claim related activities, as needed
? Handle high levels of stress satisfactorily and be congenial with other customers, clients, and employees at all times
? Answer emails on the Shasta website
? Approve providers to access the provider portal on the Shasta website
Decision Making Authority:
? Cannot work on or handle own claims or inquiries
? Can authorize prescription refills, when appropriate
? Has complete access to the customer service module
Relates with others:
Inside office: Claims Examiners, Customer Service, and other Health Benefits staff
Outside office: Participants, Providers, Pharmacy Benefit Managers, Networks, and Clients
Requirements for the Position:
? Must have an open mind, and the ability to think outside the box
? Ability to project a positive and friendly attitude at all times
? Must be customer service oriented and have a passion for helping people
? Must be willing to go above and beyond to ensure full customer satisfaction
? Must have previous customer service experience, preferably in a call center
? Must be willing to participate in customer service training
? Must be willing to read and understand client benefit plans and summary plan descriptions
? Must have a good attendance record (including tardiness)
? Must participate in HIPAA, DOL, and TPA standards training
? Fluent Spanish speaking, reading, and writing is preferred
Knowledge and skills needed:
? Must have the ability to learn the customer service module (CSI), claims module (ECI), and additional required software or systems
? Must have strong and accurate typing skills (45-60 words per minute)
? Must have the ability to work quickly and accurately while multitasking
? Must have good decision making skills
? Must have the ability to learn benefit plans and summary plan descriptions
? Must have a strong understanding of FSA and COBRA
? Must demonstrate excellent verbal and written communication skills
? Must have excellent memory skills
? Health insurance industry experience is preferred
Education and Training:
? High School Diploma or Equivalent
? Successful completion of the in-house training program
Work Arrangements: This position is temporarily eligible for remote work, after initial training
Reports to: Customer Service Manager
Updated: October