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Customer Service Representative

    • Job Tracking ID: 512689-596880
    • Job Location: Milwaukee, WI
    • Job Level: Mid Career (2+ years)
    • Level of Education: High School/GED
    • Job Type: Full-Time/Regular
    • Date Updated: November 02, 2017
    • Years of Experience: 2 - 5 Years
    • Starting Date: ASAP
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Job Description:

The position of the Customer Service Representative is intended to meet the needs of iCare members, potential enrollees and providers by providing a resource by phone, to answer member and provider inquiries related to benefits, eligibility and claims, coordinate/assist with member transportation needs, assist in care coordination by working with iCare staff, and perform other duties as assigned.

  1. Provides program, benefit, eligibility, claims information and describes iCare services to potential and new members via telephone and in writing.
  2. Provide responses to provider inquiries submitted to the dedicated Provider email box on spreadsheets within the designated timeframes based on the volume of claim reviews submitted by the provider.
  3. Arranges for translators and translation services, when necessary.
  4. Address phone calls from iCare members.
  5. Assists with transportation services for members to Medicaid approved locations when necessary.
  6. Research issues and uses judgment for obtaining relevant information.
  7. Develops and maintains positive customer relations and coordinates with various functions within the company to ensure customer (member or provider) requests and questions are handled appropriately and in a timely manner (24 hours in most cases, longer as needed and customer is provided daily status updates until issue addressed)
  8. Documents member information, including demographics and contacts made with customers within the Trizetto Call Tracking system.
  9. Meets individual performance and quality goals

Experience and Skills:

  1. 2-3 years of demonstrated customer service experience in a health insurance setting with a general understanding of claims processing and benefits.
  2. Previous experience in Medicaid and / or Medicare environment.
  3. Experience in managed health care systems and customer service business practices.
  4. Strong interpersonal skills and ability to work effectively with persons with disabilities and a wide variety of ethnic, cultural, and socio-economic backgrounds.
  5. Ability to develop and maintain effective working relationships with providers, members, other agencies and organizations.
  6. Ability to effectively and satisfactorily resolve member and provider issues within specified timelines.
  7. Possess knowledge and experience of appropriate telephone skills.

 

 
 
 
  • Independent Care Health Plan
  • 1555 RiverCenter Drive, Suite 206
  • Milwaukee, WI 53212
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