Job Description

Job Description

Job Description

Description:

· Provide quality customer service. Educates prospective members, designated family members, and caregivers regarding benefits and plan options.

· Accurately explains benefits and plan options in person, via email or telephonically.

· Provides follow-up with prospective members demonstrates active listening skills, determining the needs assessment and clarifying the customer’s wants versus needs and identifying and explaining the plan solution.

· Consistently meets and/or exceeds the departmental KPI production standards, including quality, productivity, and adherence to schedule and attendance. This includes inbound call volume from our marketing efforts and outbound calls to members.

· Responds appropriately and in a timely fashion to prospective member/internal staff/providers by answering telephonic and written inquiries concerning benefits, eligibility, referrals, enrollments, and all other issues following departmental policies and procedures and job aids. Takes ownership of the issue, focusing on providing solutions and options for members, as necessary through resolution of member issue.

· Increases member satisfaction by following up and resolving member issues, complaints, and questions in an efficient, timely and accurate fashion; coordinates resolution with providers and other departments as needed. This is a critical element of retention.

· Participates in member calling projects as assigned by management to support the overall Verda Health Plan goal of membership retention.

· Follows policies and procedures and job aids to maintain efficient and complaint operations; communicates suggestions for improvement and efficiencies to management; identifies and reports problems with workflows following proper departmental procedures; actively participates in departmental staff meetings and training sessions.

· Follows all appropriate Federal and State regulatory requirements and guidelines applicable to Verda Health Plan operations, as documented in company policies and procedures. Follows all HIPAA requirements.

· Documents transactions by completing applicable member forms and summarizing actions taken in appropriate computer system and following standards set by the department or by other authorized individuals.

· Proactively engages and collaborates with other departments as required.

· Demonstrates personal responsibility and accountability by meeting attendance and schedule adherence expectations.

· Achieves individual performance goals established for this position in call quality, attendance, schedule adherence, and individual performance goals relating to call center objectives.

Minimum Qualifications

· Required: High School diploma or equivalent required.

· Bilingual and fluent in English AND one of the following Korean, Vietnamese, or Spanish

· 1-2 years call center or related TeleSales and/or customer service experience required.

· 1-2 years of prior experience re benefits, including Medicare Advantage Plans

· Experience in the healthcare, insurance, or pharmacy industry is highly desirable.

· Ability to maintain calm demeanor, including during charged situations.

· Data entry and general computer skills required.

· Effective communication (oral and written) skills. Professional /pleasant telephone manner required.

· Professional /pleasant telephone manner required.

· Ability to handle large call volume, while always providing excellent customer service

· Demonstrated efficiency/effectiveness is an environment with a high call volume.

Professional Competencies

· Integrity and Trust

· Customer Focus

· Functional/Technical Skills

· Written/Oral Communications

· Critical/Analytical Thinker

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