Representative, Customer Service I (FULLY REMOTE BUT MUST RESIDE IN MD, VA, or DC) - Evolent Health

**Your Future Evolves Here** Evolent partners with health plans and providers to achieve better outcomes for people with most complex and costly health conditions. Working across specialties and primary care, we seek to connect the pieces of fragmented health care system and ensure people get the same level of care and compassion we would want for our loved ones. Evolent employees enjoy work/life balance, the flexibility to suit their work to their lives, and autonomy they need to get things done. We believe that people do their best work when they're supported to live their best lives, and when they feel welcome to bring their whole selves to work. That's one reason why diversity and inclusion are core to our business. Join Evolent for the mission. Stay for the culture. **What You'll Be Doing:** Our customer service team offers candidates the opportunity to make a meaningful impact by providing exceptional support to our valued customers, fostering a sense of job satisfaction through problem-solving and positive interactions. Our team values collaboration, continuous learning, and a customer-centric approach, ensuring that every team member contributes to providing better health outcomes. **Collaboration Opportunities:** + Customer Service Representatives (CSR's) will be working with and providing support to health plan members, providers and/or their representatives. Leadership rewards and recognizes CSR's regularly for performance in an environment that challenges while providing clear direction and support to foster success in the role. **What You Will Be Doing:** + Answer and manage inbound inquiries regarding health plan benefits and claims, eligibility, medical and other healthcare procedures, billing and payments and other related topics from customers in a prompt, courteous manner. Conduct out-bound and/or return calls to customers as necessary. + Ask appropriate questions and listen actively to identify specific questions or issues to provide appropriate response and type of assistance the customer needs while documenting relevant information in a clear and concise manner in computer systems. + Communicate and partner with customers tactfully and empathetically to resolve issues, using clear language translating healthcare-related jargon and complex processes into simple, step-by-step instructions customers can comprehend and act upon. + Handle and process customer complaints/ grievances while applying appropriate conflict management skills to de-escalate potentially stressful situations. + Meet the performance goals established for the position in the areas of efficiency, accuracy, quality, member satisfaction and attendance. Adhere to all applicable department, organization and/or regulatory policies and procedures. + Read, comprehend, and verbalize processes and procedures of the organization and of health insurance coverage. + Training includes a virtual classroom environment with trainers who have experience working within the Evolent Customer Service Operations (CSO) call center. Training Hours are 8:00am - 4:30pm CT Monday-Friday (for approximately 6-weeks). Trainees will be required to attend the entirety of training, successfully complete the required training schedule, and demonstrate proficiency of the material at the end of training. + Hours of Operation: 6 days a week, 8:00am - 9:00pm ET (hours depend on the client to which you are assigned, and your shift will be determined during training if not before). **Qualifications Required and Preferred:** ****MUST RESIDE IN MD, VA, or DC**** - Bilingual in Spanish & English (validated via bilingual assessment upon offer acceptance) - **HIGHLY PREFERRED** - High school diploma or GED - **Required** - At least 1 year call center experience - **Required** - Ability to handle a heavy call volume of 50-100 calls daily - **Required** - Demonstrated ability in using computer and Windows PC applications, which includes strong keyboard and navigation skills, ability to type 35 WPM and learn new computer programs - **Required** - Ability to work regularly scheduled shifts within hours of operation including the training period, where lunches and breaks are scheduled, with the flexibility to adjust daily schedule, and work over-time and/or weekends, as needed - **Required** - Demonstrated ability to take an educative approach, listen skillfully, collect relevant information, determine immediate requests and identify the current and future needs of the customer, answering questions and informing of health plan policies, procedures, or decisions - **Required** - Ability to maintain strict confidentiality of protected health information - **Required** - This is a work from home position, which requires a quiet, private workspace without noise and distractions, and reliable internet connectivity provided through a wired connection with a minimum of 100 MBPS speed. A mobile, hot spot, or WiFi connection is NOT acceptable - **Required** - 2+ years at a health plan, TPA or related call center setting - **Preferred** - Knowledge of managed care, Commercial, Marketplace, Medicaid and/or Medicare programs; knowledge of medical policy benefits and exclusions - **Preferred** **Technical Requirements:** We require that all employees have the following technical capability at their home: High speed internet over 10 Mbps and, specifically for all call center employees, the ability to plug in directly to the home internet router. These at-home technical requirements are subject to change with any scheduled re-opening of our office locations. **Evolent is an equal opportunity employer and considers all qualified applicants equally without regard to race, color, religion, sex, sexual orientation, gender identity, national origin, veteran status, or disability status.** **If you need reasonable accommodation to access the information provided on this website, please contact** **recruiting@evolent.com** **for further assistance.** The expected base salary/wage range for this position is $17.30-18.00. This position is also eligible for a bonus component that would be dependent on pre-defined performance factors. As part of our total compensation package, Evolent is proud to offer comprehensive benefits to qualifying employees. All compensation determinations are based on the skills and experience required for the position and commensurate with experience of selected individuals, which may vary above and below the stated amounts. Don't see the dream job you are looking for? Drop off your contact information and resume and we will reach out to you if we find the perfect fit! For more insights about Evolent Health, click on Life At Evolent (https://www.evolent.com/) to learn more!