The Customer Services Representative provides comprehensive customer service to members, providers and prospective members. The primary responsibilities include but are not limited to documenting all customer contacts into the tracking system, process complaints, conduct outreach efforts, assist in PCP selection, conduct new member orientations, claims review inquiries, handle provider and utilization management inquiries, etc.



Job Description

Record and respond to all Customer contacts and update in tracking system. Manage and ensure appropriate follow-up and closure for all customer contacts.

Provide on-site as well as telephone orientations to new and existing members.

Process and resolve complaints and record given information in the system.

Assist members with the selection and assignment of PCP.

Update all member demographic changes.

Provide all benefit/service related information to members, perspective members and providers.

Perform retention efforts for all lines of business.

Handle roster Inquiries

Handle disenrollment inquiries from members, providers and regulatory agencies.

Handle provider inquiries.

Schedule marketing appointments for prospective enrollees

Respond to all claim billing inquiries from providers and members

All other duties and special projects as assigned by Associate Executive Director



Minimum Qualifications

High School graduation or evidence of having satisfactory passed a High School Equivalency Program; and

Minimum 1 year experience in a call center environment or a satisfactory equivalent combination of education, training and experience.

Proven experience in providing excellent service to customers



Professional Competencies

Integrity and Trust

Customer Focus

Functional/Technical skills

Written/Oral Communication