Call Center Representative

• ** Need At Least 1 Year Healthcare and 2 Years Call Center Experience ***
? ** Must Live In Tallahassee or Surrounding Area ***? * Remote Position But If Must Come To The Tallahassee Office If Needed **? Training is Mon-Fri 8am - 5pm EST / Shift will be an 8-hour shift between Mon-Fri 8am - 8pm *

Job Summary:

The Call Center Representative is a front-line service position aiding state benefit system members and providers regarding programs, policies, and procedures. Responsibilities include answering incoming calls related to eligibility, benefits, claims, and authorization of services from members or providers.

Responsibilities:

Available to work scheduled work hours based on operational needs

Accurately respond to inbound phone calls and processing provider and member inquiries

Under general supervision, resolve customers' service or billing complaints by demonstrating sound judgement

Contact customers to respond to complex inquiries or notify them of claim investigation results

Refer unresolved customer grievances, appeals, and claim resolution to designated departments

Keep records of customer interactions and transactions

Actively listen and probe callers to determine the purpose of the calls

Research and communicate information regarding member eligibility and claims status

Assume responsibility for self-development and career progression

Educate providers on how to submit claims and when/where to submit a treatment plan

Perform necessary follow-up tasks to ensure member or provider needs are completely met.

Support team members and participate in team activities

Must Have:

Experience with Microsoft Word and Powerpoint

2 years of Call Center Experience

1 year of Healthcare Experience

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