Customer Service Representative

hace 1 semana

Xico, México Helpware Inc. A tiempo completo
About Us

Helpware Inc. is a technology-driven company that provides Customer Experience & Operational Support for modern companies. Our team of professionals is driven by the purpose of providing best-in-class value-adding services to our partners by leveraging our empowered teams, innovative solutions, and technologies.

Position Summary

As a Member Services Advocate, you will be a part of a team that transforms customer service into Customer Care by delivering an amazing experience. You will assist beneficiaries with a wide range of critical services, which include but are not limited to updating account information, providing plan information, and resolving issues with utilization of the plan.

Responsibilities
  • Update account information such as billing options and changes of address or phone numbers.
  • Research premium billing discrepancies and prescription claims processed.
  • Educate beneficiaries on how the plan works, including benefits, cost sharing, and levels of coverage.
  • Submit mail requests for beneficiaries such as ID cards and formularies.
  • Look up medicines on the formulary to verify if they are covered, the tier and copay level, and if a drug is not covered, provide an explanation as to why.
  • Display a positive demeanor, technical accuracy, and conformity to company policies.
  • Understand CMS Guidance and ensure applicable Exhibits are being mailed per CMS Guidance.
  • Ensure HIPAA regulations are maintained within the immediate environment.
  • Responsible for concise and detailed notations as it pertains to member records.
  • Handle outbound calls for purposes of validating information.
  • Handle inbound calls by assisting members with a high level of accuracy and efficiency.
  • Escalate any member issues to management as necessary.
  • Maintain a high level of call quality as set by client standards, which includes a 95% quality score, and answering 80-85% of calls within 30 seconds or less.
  • Communicate with coworkers, management, staff, customers, and others in a courteous and professional manner.
  • Conform with and abide by all regulations, policies, work procedures, and instructions.
  • Respond promptly when returning telephone calls and replying to correspondence and faxes.
  • Act, dress, and behave in a professional manner to reflect a positive image of the company.
Monthly Goals
  • Meet average QA score of 95%
  • Comply with attendance guidelines of 98%
  • Schedule adherence of 90% or higher
  • Maintain AHT below certain standards
Requirements
  • Associate Degree preferably in Healthcare
  • Minimum 3 years working in a fast-paced high-volume call center environment, retail customer service, preferably in healthcare or hospitality
  • Ability to multi-task effectively with strong attention to detail when documenting customers' reasons for calling
  • Excellent written communication skills
  • Excellent problem-solving abilities
  • Must love customer service with excellent listening skills, demonstrate empathy, and the ability to educate customers
  • Ability to de-escalate matters in a calm and professional manner
  • Comfortable with technology and navigating numerous systems simultaneously
  • Unwavering dedication to serving a customer that has complex needs
  • Requires strong technical skills with Microsoft Office (Excel, Word, and Outlook)
  • Must have an energetic phone presence - professional etiquette over the phone, through written and face-to-face communication
  • Self-motivated, confident, reliable, and committed to customer satisfaction
  • Adherence to following internal policy
  • Ability to interact professionally and maintain effective working relationships with superiors, coworkers, customers, and others
  • Ability to break down complicated information into simple messages for the caller

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