Customer Service Representative

Description of Duties:

• Receive, answer and/or record telephone/correspondence/e-mail inquiries from subscribers, providers, and other consumers relating to areas of coverage, payment of claims, membership status, medical management intake calls, etc., under the various EmblemHealth medical/surgical, dental, hospital and Medicare plans.

• Review inquiries, correspondence and email receipts. Prepare email resolutions, letters (form or narrative letter) and/or claims payment process adjustments.

• Perform written and verbal duties of the position to meet company goals for production and accuracy.

• Perform related claims approving and clerical work as assigned.

• Perform other duties as assigned or required

  Job Requirements:
  Qualifications: 

• Must be able to work under pressure, handle stressful situations effectively and deal politely with subscribers and providers on the telephone, in person, and email/correspondence.

• Ability to detect and relate problem service issues to management.

• Ability to speak well on the telephone and maintain a positive telephone personality.

• Must be able to compose clear concise letters.

• If designated, sort and screen correspondence receipts and resolve via coding of additional payment, possibly including salvage and/or completion by letter.

• Typing and PC skills.

• Ability to adapt to change and address multiple issues simultaneously.

• Good organizational skills.

• Must be available for training.

• Regular attendance is an essential function of the job

Education and Experience:

• A minimum of two (2) years’ experience in customer service; 1 year must be in a call center setting.

• A college degree is preferred.

• Health insurance experience is a plus

 Test Subjects: