Customer Service Representative I (LBS)

Job Description: Summary: The Customer Service Representative resolves customer inquiries via telephone, fax, off-phone work, and email concerning, but not limited to, account benefits, claim payments, and enrollment in accordance with Operational Risk Audit (ORA), HIPAA, and other legislative requirements. This role requires participation in training immediately upon hire to become proficient in one line of business to independently perform the duties outlined below. Training in the second line of business must be initiated and completed within 12 months of proficiency in the first line of business to cross-functionally support the department. Initial line of business will be determined by the area of greatest need at time of hire. Essential Accountabilities: Level I • Researches, documents, interprets, and responds to inquiries from internal and external customers, business partners, and special groups concerning our products, services, and policies in accordance with ORA, HIPAA, and other legislative requirements. • Researches and responds to questions related to claims, onboarding, effectuation, retention, provider inquiries, and any other complex inquiry. Identifies and follows through on issues impacting the Health Plan and customer experience. • Provides service to customers and business partners while responding in a professional, efficient, and timely manner to enhance member and provider satisfaction and retention. Must exercise tact, patience, and professionalism at all times in responding to internal/external customers. • Utilizes appropriate resources to resolve customer inquiries accurately & efficiently, resulting in acceptable quality, First Call Resolution, and performance. • Develops effective internal working relationships for improved communication and collaboration. • Shares ideas and solutions to improve processes, procedures, and systems. • Participates in meetings, training, and skill development to support career path and individual development plans. • Consistently demonstrates high standards of integrity by supporting the Lifetime Healthcare Companies’ mission and values, adhering to the Corporate Code of Conduct, and leading to the Lifetime Way values and beliefs. • Maintains high regard for member privacy in accordance with the corporate privacy policies and procedures. • Regular and reliable attendance is expected and required. • Performs other functions as assigned by management. Level II (in addition to Level I Accountabilities) • Provides expertise, daily support, mentoring, coaching, and guidance to other advocates. • Assists with job shadowing and new employee training for multiple lines of business. Minimum Qualifications: NOTE: We include multiple levels of classification differentiated by demonstrated knowledge, skills, and the ability to manage increasingly independent and/or complex assignments, broader responsibility, additional decision making, and in some cases, becoming a resource to others. In addition to using this differentiated approach to place new hires, it also provides guideposts for employee development and promotional opportunities. All Levels • High School diploma or equivalent. Customer service experience preferred. • Strong communication skills across multiple channels including, but not limited to, voicemail, email, outbound calls, etc. Adept at communicating effectively and diplomatically while working as a collaborative team member. • Strong organizational skills and ability to prioritize, work in fast paced environment, and remain professional and focused under multiple pressures and demands. • Ability to efficiently resolve customer concerns by actively listening to the customer, navigating screens on the computer, typing call documentation, and speaking to the customer simultaneously. • Excellent computer skills required, including the ability to navigate in a Windows environment. Skillful at working between multiple programs and applications at the same time. • Proven reasoning and problem-solving skills. • Ability to work occasional overtime as required to meet business needs. Level II (in addition to Level I Qualifications) • Performance rating of “Performing” or above in Level I for a consecutive 12 month period. • Must be consistently proficient in all ancillary products. • Ability to support specialized Groups to provide custom rules and regulations as applicable based on multiple lines of business. • Proven ability to efficiently resolve complex and escalated issues with minimal direction. • Advanced system and navigational skills. • Demonstrated global thinking and initiative to recognize opportunities within the team. Physical Requirements: • Ability to work while sitting and/or standing at a workstation viewing a computer and using a keyboard, mouse and/or phone for three (3) or more hours at a time. • Ability to hear, understand, and speak clearly while using a phone, with or without a headset. • Ability to arrive at work on time and as scheduled. • Ability to meet minimum performance metrics. ************ In support of the Americans with Disabilities Act, this job description lists only those responsibilities and qualifications deemed essential to the position. Equal Opportunity Employer Compensation Range(s): Minimum: $20/hr - Maximum: $24.43/hr The salary range indicated in this posting represents the minimum and maximum of the salary range for this position. Actual salary will vary depending on factors including, but not limited to, budget available, prior experience, knowledge, skill and education as they relate to the position’s minimum qualifications, in addition to internal equity. The posted salary range reflects just one component of our total rewards package. Other components of the total rewards package may include participation in group health and/or dental insurance, retirement plan, wellness program, paid time away from work, and paid holidays. Please note: There may be opportunities for remote work on all jobs posted by the LBS Recruitment team. This decision is made on a case-by-case basis. All qualified applicants will receive consideration for employment without regard to race, color, religion, sex, sexual orientation, gender identity, national origin, disability, or status as a protected veteran.