Customer Services Specialist

Job Summary:
This position has the following primary objectives related to customer relations for all HAP product lines:

1. Provide follow-up and courteous, prompt resolution to member inquiries by conducting thorough investigations and fully educating members and customers.

2. Support corporate and departmental goals, member enrollment activities, and product implementations.

3. Research, investigate, and resolve service failures. Improve the customer experience by identifying root causes and trends, and recommending resolutions for service recovery and retention.

4. Educate members and prospective members to promote HAP as the health care coverage of choice.

Duties and Responsibilities:

• Respond to inquiries by telephone, mail, and in person; research and resolve inquiries, complaints, and appeals in accordance with department standards, policies, and procedures; direct inquiries to supporting departments for appropriate action and resolution.

• Educate existing and potential members on policies, procedures, product offerings, benefit plans, and coverage provisions related to all HAP products.

• Accurately document all incoming inquiries to track member inquiry history and trends.

• Maintain confidentiality in accordance with Privacy and HIPAA regulations.

• Proactively seek training and development to enhance skills and abilities.

• Monitor workflow inbox and outstanding cases to ensure all inquiries receive an appropriate and timely response; contact members (by phone and/or in writing) as needed to ensure timely resolution and follow-up.

• Interact professionally with support departments to ensure member needs are met.

• Develop and maintain strong business relationships with inter-departments; stay informed of changes in policies and procedures that may impact department operations and member/customer service.

• Attend training, development sessions, and continuing education opportunities offered by Customer Service to maintain and enhance performance.

• Interact with providers and their staff to obtain information necessary to resolve customer inquiries and complaints.

• Ensure compliance with all department and corporate standards, policies, and procedures.

• Recommend process improvements based on observations and trends identified while interacting with internal and external customers.

• Coordinate and assist with departmental projects, member enrollment periods, outreach activities, and corporate initiatives.

• Perform other related duties as assigned.

• Minimum of two (2) years of recent Customer Service or Call Center experience within the last three years.

• Must be dependable.

• Demonstrate a high degree of integrity, patience, maturity, empathy, tact and Diplomacy.

• Demonstrate problem solving skills, flexibility, good judgment and ability to provide service excellence.

• Demonstrate the ability to handle assigned projects from start to successful completion including appropriate follow-up and documentation.

• Demonstrate the ability to handle multiple priorities concurrently in a timely and accurate manner.

• Demonstrate strong interpersonal, listening, verbal communication and business writing skills.

• Demonstrate efficiency in using a PC and various Microsoft programs.

• Fundamental understanding of HMO/PPO/POS delivery system and claims billing.

• Must be able to work flexible shifts, overtime including evenings and weekends as requested and/or scheduled.

Education

Required Education:

• Course in Medical Terminology (required within six months post-employment).

• Associates Degree, OR

• A minimum of four (4) years of recent, related customer service experience may be considered in lieu of a degree.