Customer Service Representative

At Vantage Health Plan, Inc ., we specialize in taking care of people: our members, our patients, and our employees.

We offer competitive salaries and great benefits Benefits include: Health, Dental, Life, Accidental Death and Dismemberment, Long Term Disability, Paid Time Off, and 401(k).

Additional earnings opportunities are available for licensed (Health & Accident) Member Services Representatives through our internal incentive program Job Summary: The Member Service Representative (MSR) is responsible for utilizing in-depth knowledge of company products over multiple lines of business to provide both telephonic and in-person service and support to Vantage Health Plan, Inc.

customers in a timely, professional, and hospitable manner.

Essential Duties & Responsibilities:
• Maintain a positive, empathetic, and professional attitude in all customer interactions
• Assist customers with questions, concerns, and complaints; acknowledging and resolving all issues promptly and professionally
• Provide explanation of benefits and claims status results
• Process payments received over the phone
• Assist with provider inquiries
• Answer Member Services’ calls by the 2nd ring, unless on another call
• Ensure that callers are not placed on hold for longer than 2 minutes
• Answer calls within 2 minutes of entering into the queues
• Document specifics of each call in the call tracking module
• Determine and classify nature of call by components of grievances, appeals, and/or coverage determinations and handle appropriately
• Promote Exchange, Short-Term, and/or Medicare products and assist with enrollment process
• Respond to voice mail at least twice daily
• Respond to Member/Provider/Inquirer’s e-mail requests on the day the e-mail was received
• Research any prescription drug issue within the day of the request
• Research any copay needed within the day of the request
• Research any bills that a member has received and respond back within 48 hours of notification
• Complete workflow assignments in OnBase daily
• Complete assignments via FaxCom daily
• Follow-up on V-Tasks to ensure timely response to customer’s inquiries
• Assist walk-ins daily
• Complete weekly breakdown of member/provider/broker/inquiry calls for auditing purposes
• Review weekly audits provided by the Member Service Auditor
• Reconcile monthly Language Line Usage with the invoice Marginal Duties:
• Appeal claims on behalf of members and providers, and provide follow-up once resolution has been determined
• Assist Production Enrollment as needed
• Assist Marketing as needed
• Other duties as assigned Job Requirements: Knowledge, Skills, and Abilities:
• High school diploma or equivalent
• Bachelor’s degree preferred but not required
• Minimum of 2 years of experience in corporate and/or customer service setting preferred
• Excellent phone etiquette skills are a must
• Ability to type minimum of 35-40WPM with accuracy
• Ability to talk and type simultaneously
• Ability to use Microsoft Office Suite (Excel, Word, Power Point, etc.)
• Ability to perform simple calculations
• Highly organized and efficient with strong attention to detail
• Excellent verbal and written communication skills
• Ability to interact effectively with all levels of staff
• Ability to perform consistently at a high level with a heavy call volume in a fast-paced call center setting Supervisory Responsibilities:
• None Supervision Received:
• Works under general supervision of Member Services Supervisor(s) and the general supervision of the Director of Member Services and Enrollment.

Working Conditions:
• This position operates in a professional office environment with opportunity to work from home upon meeting training and eligibility requirements
• This is a full-time position (40 hours/week)
• Departmental shifts are worked on a rotating basis o 7AM-4PM o 8AM-5PM o 9AM-6PM o 11AM-8PM
• Holiday hours required include: o New Year’s Day o Day after Thanksgiving or Christmas Eve
• Overtime may be required
• Travel may be required Physical Demands The physical requirements described here are representative of those that must be met by an employee to successfully perform the essential functions of this job.

Reasonable accommodations may be made to enable qualified individuals with disabilities to satisfactorily perform these essential functions without causing an undue hardship for the employer.

While performing the duties of this job, the employee is required to remain in a stationary position for long periods of time and must frequently move about the office.

The employee must constantly operate a computer and other office equipment such as phones, keyboards, printers, and copiers.

The employee is regularly required to communicate with others via phone, email, etc.

Occasionally, the employee is required to move up to 10 pounds and may, at times, be required to move up to 50 pounds.