Allied Benefit Systems, Inc

Allied Benefit Systems, Inc

Job Description

Job Title: Virtual Customer Service Representative

Department:Customer ServiceFLSA Status:Non-Exempt Job Status: FT

Reports To:VCSR SupervisorPositions Supervised: None

Work Schedule: Rotating shifts between 7:30 AM to 7:00 PM M-Th, 8:00AM to 5:00 PM F and 9 - Noon Saturdays

POSITION SUMMARY

Interact with plan members and providers in a virtual setting using VOIP to answer questions or provideinformation in response to inquiries about employee benefit plans or claim issues; and be able to handle andresolve issues and complaints resulting from the calls. Plan members may be either English or Spanish speaking.

ESSENTIAL FUNCTIONS

  • Confer with members and providers by telephone to provide information about employee benefit plans and/or claim issues or to obtain details of inquiries. Confer with Spanish speaking members and providers by telephone to provide information about employee benefit plans and/or claim issues or to obtain details of inquiries.
  • ** Keep records of member and provider interactions and transactions, recording details of inquiries, complaints, and comments, as well as actions taken.
  • Resolve member or provider inquiries by verification of employee benefits or review of claim adjudication.
  • Check to ensure that appropriate changes were made to resolve members' or providers' inquiries.
  • Contact members or providers to respond to inquiries or to notify them of claim investigation results and any planned adjustments.
  • Refer unresolved members' or providers' inquiries to designated departments for further investigation.
  • Check repositories (Alchemy, I status DB, Appeals DB and Med Review DB) for receipt of claims and other faxed or mailed information, (OI, Med Review, Student Status, other documentation sent to member) upon receipt of member or provider call.
  • Complete adjustment request forms, accident detail forms, other insurance (OI) forms and temporary change of address records.
  • Obtain and examine all relevant information to assess validity of complaints and to determine possible causes such as participant's eligibility, timely filing of claim or member's benefit plan design.
  • Review employee benefit plan to determine whether a particular benefit is covered by the plan.
  • Review claim(s) adjustment(s) to verify accuracy of original adjustment request.
  • Meet and sustain productivity and quality metrics determined by management.
  • Be able to take a minimum of 50 to 75 calls per day depending on queue assignment.

POSITION QUALIFICATIONS

  • Accountability - Ability to accept responsibility and account for his/her actions.
  • Autonomy - Ability to work independently with minimal supervision.
  • Communication and Presentation, Oral - Ability to communicate and present information effectively with external and internal customers using the spoken word.
  • Customer Oriented - Ability to take care of the members’ and providers' needs while following company procedures.
  • Detail Oriented - Ability to pay attention to the minute details of members' or providers' inquiries.
  • Empathetic - Ability to appreciate and be sensitive to the feelings of others and to show consideration for and maintain good relations with all callers and co-workers.
  • Home Office Requirements - Employee must be able to provide an appropriate safe, ergonomically correct and free of distractions office space, in which to work. DSL or Business class cable is required and at employee's cost, company provides computer.
  • Judgment - The ability to formulate a sound decision using the available information.
  • Problem Solving - Ability to resolve or to deal proactively with member or provider inquiries.
  • Resilient - Ability to recover from difficult or irate members or providers calls and sustain positive and professional demeanor.

EDUCATION:

College degree preferred, but not required.

EXPERIENCE:

4 plus years in call center environment with third party administrator, health insurance, or

employee benefits company.

SKILLS & ABILITIES:

Ability to comprehend and utilize call center software applications in a virtual computerized environment. Typing 35 WPM, Microsoft Office and intermediate computer literacy skills.

OTHER REQUIREMENTS:

Able to demonstrate outstanding customer service skills through awards, recognition or employer performance reviews. Able to achieve 75% or higher in Customer Service Skills assessments. Able to achieve 75% Excel Worksheet File Management assessment.

WORK ENVIRONMENT:

This position is virtual with in-office training and continuing education hosted in Chicago and virtually.

At home work station must have high-speed internet connection, company will provide computer.

The company has reviewed this job description to ensure that essential functions and basic duties havebeen included. It is not intended to be construed as an exhaustive list of all functions, responsibilities, skillsand abilities. Additional functions and requirements may be assigned by supervisors as deemedappropriate.

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