CLIENT SERVICE REPRESENTATIVE

REPORTS TO:Client Service Representative Supervisor
SUPERVISES: None

JOB SUMMARY: This position is responsible and accountable for providing customer service and support to all clients, primarily by answering and responding to all inbound calls from providers, members, and clients. These call types include locating members; verifying membership eligibility; locating providers and processing referral notifications. As well, administrative tasks generated from the call are performed with this position. This position is responsible and accountable for quality service delivery; understanding and maintenance of applicable policies and procedures; and maintenance of minimum performance metrics both individually and at the team level. This position’s work hours could vary according to business demands. This means that shift changes, with reasonable notice, are possible to include work hours as well as work days.  This position is also subject to mandatory overtime based on business needs.

MINIMUM QUALIFICATIONS:

Education:		High school diploma or equivalent.  Two years of advanced education/college or graduation from an accredited business school preferred.
Experience:		Minimum one year inbound call center experience in the medical field required, preferably with multiple systems;  recent managed care; physician office; hospital business office or health care industry background in customer service required to the degree that a strong knowledge of medical and/or behavioral terminology is evident.
Knowledge/skills:		Demonstrated ability to type 50 words per minute with 90% accuracy while engaged in a telephone conversation Demonstrated proficiencies with basic computer skills to include how to navigate, accessing of various programs and use of Microsoft Outlook email Must be an effective communicator, both written and verbally – able to clearly articulate information to both providers and members Demonstrated success in a call center environment to include multi-tasking as well as the ability to focus singularly on the task at hand Must be flexible, willing to accept changes occurring in a dynamic environment

ACCOUNTABILITIES:

Overall Job Performance/Responsibilities:

70%         Delivers professional customer service to members, providers, and clients in accordance with all policies and procedures. Must maintain or exceed minimum performance standards as defined in goals document AKA –  Monthly T-form. Basic standards include accuracy, call metrics, attendance, and customer satisfaction.
10%         Performs all administrative functions as required in our contractual agreements with our clients.
10%         Maintains current policy and procedure information by self-study of corporate resources; attending JIT (Just-In-Time) training sessions; and by seeking knowledge.
10%                       Accountable for creating and fostering a team environment through participation in team activities; individual morale; willingness to pitch in and help with special projects and to be a part of the solution.

Customer Services-Internal:

• • Supports and foster a positive working environment;
  • Identifies and resolves potential personnel/peer problems and issues proactively, readily utilizing the Sr. Director of Operations as a resource;
  • Communicates to Sr. Director of Operations all non-clinical problems, issues and/or concerns as they arise;
  • Communicates to the Director of Utilization Management any issues or concerns related to quality of care, following appropriate Health Integrated policies/procedures; 
  • Maintains a courteous and professional attitude when working with all Health Integrated staff members and the management team; and,
  • Actively participates in team meetings and all team-building events.

Customer Services-External:

• • Timely identifies and communicates to applicable practitioners, providers and the health purchaser staff all issues and concerns related to the case at hand;
  • Communicates to QI staff any issues or concerns related to quality of care, following appropriate Health Integrated policies/procedures; 
  • Works, communicates and collaborates in harmony and in a courteous and professional manner with the patient, practitioner, provider and multidisciplinary health care team members all issues, concerns and/or as the UM Plan is revised and/or new services are implemented/terminated; 
  • Serves as a liaison and patient advocate when deemed applicable for quality of care and cost outcomes; and,
  • Communicates appropriately and according to policy, and/or regulatory requirements with the practitioner(s), provider(s), patient/patient’s legally appointed representative any UM coverage determination(s).

 

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