Customer Service Rep I

SUMMARY

Curative is looking for a Customer Services Representative 1. Candidates will utilize their previous experience in the Medical Field/Customer Care to increase satisfaction and retention for our clients, providers and members with accurate, consistent, timely and meaningful information. This role provides support to clients, providers and members while building rapport and collaborative relationships with current and prospective clients, providers and members in accordance with compliance guidelines. This is a remote call center position.

ESSENTIAL DUTIES AND RESPONSIBILITIES

Answering phone calls and emails, assisting and resolving Provider and Member related requests regarding but not limited to the following: 

• Commercial and Government Health Plan interpretation and benefits
• Providing all aspects of member benefit information, eligibility, referrals/authorization and claim processing information with 100% accuracy
• Directing calls and emails to correct department and escalating as needed 
• Building and maintaining solid client, provider and member relationships by handling questions, concerns, resolving issues/complaints with speed and professionalism while maintaining confidentiality per HIPAA guidelines. 
• Documenting provider and member complaints, determines appropriate course of action, and follow-up to ensure the complaint is resolved.
• Providing Member outreach calls as needed.
• Documenting all interactions and transactions with the caller in the appropriate areas. 
• Assisting Members with PCP assignments and re-assignments.
• Work adhering to US regulatory and Quality System requirements.
• This position assumes and performs other duties as assigned.
• WORK SHIFTS AVAILABLE Monday - Friday 8am - 5:00pm CST

QUALIFICATIONS

To perform this job successfully, an individual must be able to perform each essential duty satisfactorily. The requirements listed below are representative of the knowledge, skill, and/or ability required. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions: 

• A 3 to 5 year related experience and/or training in a call center environment in healthcare, insurance plan areas including knowledge of basic claim processing. 
• Excellent attendance is critical to success in this position.
• Excellent computer and phone skills, attention to detail, process and policy adherence. 
• Excellent verbal and written communication skills. 
• Strong interpersonal skills. 
• Active listening skills to accurately respond to inquiries and requests. 
• Exceptional organizational skills, retention of policy and process a must. 
• Intermediate skills minimum in google and microsoft office suite of products a must.

 EDUCATION and/or EXPERIENCE 

• High School diploma or GED equivalent 
• Bilingual in English and Spanish preferred

CERTIFICATES, LICENSES, REGISTRATIONS 

• Administrative/Healthcare a plus but not required

WORK ENVIRONMENT

• Remote position. 
• Must have a quiet place, secure, with no distractions to perform duties for work from home. 
• Must have password protected, stable internet access - stipend will be provided. 
• Work location MUST be secure and private to maintain HIPAA compliance for work from home. 
• Office equipment will be supplied including: PC, monitor, keyboard, mouse, headset. 
• While performing the duties of this Job, the employee is regularly required to sit; use hands to handle or feel; talk; and hear.
• The employee is frequently required to reach with hands and arms. 
• Specific vision abilities required by this job include close vision, distance vision, color vision, peripheral vision, depth perception and ability to adjust focus.

TRAINING EXPECTATIONS 

• You will attend a 3 week minimum remote training program. Attendance is mandatory for the full 3 week training program. 
• Training will be Monday through Friday 8am - 5pm CST. 
• You will be required to take daily competency exams and a retention exam on the Friday of both weeks of training. Passing grades are 80% or above. 
• We also request, with the exception of emergencies, that you do not request any time off within the first 90 days of employment.