SERVICE REP 1 - Aultman Health Foundation

PURPOSE OF POSITION:

The purpose of the Service Rep I is the primary contact with all enrollees, prospective enrollees, providers, brokers and companies and as such, must consistently relay the positive aspects of AultCare to every caller.  The representative is responsible for accurately, courteously and promptly transacting all callers in a highly professional manner. 

RESPONSIBILITIES & EXPECTATIONS:

·         Responds to customer inquiries via telephone and written correspondence regarding insurance benefits, provider contracts, eligibility and claims.

·         Answers incoming calls and emails in a courteous and professional manner.

·         Analyzes problems and provides information/solutions.

·         Places follow-up phone calls and emails to answer customer questions that are routine in nature.

·         Based on department need, may be required to assist with walk-in clients

·         Operates a PC or thin client to obtain and extract information.

·         Documents inquiry outcomes for accurate tracking and analysis.

·         Maintain up-to-date tools and resources and utilize in a manner which allows calls to stay within Customer Service department for resolution.

·         Performs basic job functions with help from co-workers and higher level personnel on non-basic issues and complex inquiries.

·         Requires basic knowledge of company services, products, insurance benefits, provider contracts, claims and pharmacy.

·         Meets quality and performance metrics.

·         Process Improvement: Continuously reviews, recommends and implements improvement steps, as needed or directed.

·         Seeks supervisory guidance/approval as appropriate.

·         Portrays professional image: follows dress code, communicates with internal and external customers in a professional manner, including appropriate verbal and written grammar.

·         Promotes and demonstrates professional standards to enhance the development of the department.

·         Practices ethical conduct.

·         Meets acceptable attendance and punctuality expectations (excluding FMLA)

The above statements reflect the general duties considered necessary to describe the principle functions of the job as identified, and is not a detailed description of all the work requirements that may be inherent to this position.

All qualified applicants will receive consideration for employment without regard to race, color, religion, sex, gender identity, sexual orientation, age, national origin, disability, or protected veteran status.  AultCare is an EEO/AA Employer M/F/Disability/Vet.

AultCare/AHF will provide reasonable accommodations to employees or applicants with disabilities, as defined by the Americans with Disabilities Act, who are otherwise qualified to safely perform the essential functions of the job, with or without accommodation, unless such accommodation would constitute an undue hardship on AultCare/AHF or poses a direct threat to the health and safety of the individual or others that cannot be sufficiently mitigated by reasonable accommodation. Any applicant or employee who requires an accommodation to perform the essential functions of his or her job or to enjoy equal benefits and privileges of employment should notify the AultCare Human Resource Department and request accommodation.  

QUALIFICATIONS:

·         Education:  High School diploma or GED required.

·         One year experience in insurance, healthcare or customer service.

·         Individual must have a good command of the English language and have the ability to communicate effectively verbally and in writing.

·         Ability to empathize and project a strong understanding of member/provider needs.

·         Previous experience with Microsoft Word, Excel and Outlook.

·         Ability to type a minimum of 40 wpm.

·         Available to work 40 hours per week anytime within the operating hours of the department, which may include weekends and holidays.

PREFERRED QUALIFICATIONS:

·         Education:  Associate degree.

·         One year experience in automated call center related to insurance or medical field.

·         Knowledge of HMO, PPO and Medicare plans/benefits.

·         Knowledge of medical terminology.

·         Bilingual English/Spanish.

WORKING CONDITIONS:

·         Office environment with moderate noise level

·         Frequent sitting, use of hands/fingers across keyboard or mouse, and long periods working at a computer.

·         Occasionally walking, standing, twisting/turning and reaching upward or forward during work day