Customer Service Representative, MercyCare Insurance - Mercyhealth

Overview:

• Representative Member Services, MercyCare Customer Service, Days, 80 Hrs / 2 wks 
• Location: MercyCare Bldg; Janesville, WI

Responds to all incoming correspondence and telephone inquiries directly related to the CSR 2 position in a professional manner consistent with the mission of the health system. Attend seminars/training sessions. May be required to work overtime during peak periods. Performs other duties as assigned.

Responsibilities:

• Responds to all incoming telephone calls.
• Resolves all inquiries in a professional manner consistent with the mission of the health system.
• Assist callers with complaints, appeals, grievances and IRO requests.
• Attend seminars/training sessions.
• Add membership to the PBM software
• Add authorizations to the PBM software
• Processing all prescription claims (DMR) through the PBM software
• Respond to 100%of overflow phone calls by the time standards for A.M. and P.M. messages
• Send out delays letters for all complaints within time standards established
• Assist in the training of employees.
• Responsible for resolving complaints within the time standards of the applicable SOP.
• Responsible for completion of all customer service functions without close supervision.

Education and Experience:

Bachelor's degree or two years of experience in the healthcare industry, as related to this position.

Special Physicial Demands:

While performing the duties of this Job, the employee is regularly required to sit, talk and hear. The employee is frequently required to use hands to finger, handle, or feel and reach with hands and arms. Specific vision abilities required by this job include close vision, peripheral vision and ability to adjust focus. The employee is occasionally exerting up to 20 pounds of force. Must use a computer, keyboard, mouse and specific computer programs as required.

Culture of Excellence Behavior Expectations: