Essential Functions: Reasonable accommodations may be made to enable individuals with disabilities to perform essential functions.
Essential Duties and Responsibilities: Include the following. Other duties may be assigned.
- Handle incoming and outbound group health plan customer service calls
- Provide support to various providers and client members
- Answer questions concerning claims status and medical pre-certification
- Interpret benefit eligibility based on the client's Summary Plan Description (SPD)
- Explain benefit determinations
- Contact providers, clients and insurance carriers as needed
- Research written and verbal inquiries in response to complex customer calls
- Answers phone calls utilizing efficient interpersonal and communication skills, as well as excellent telephone and customer service skills and etiquette
- Exhibits attention to detail and a strong work ethic
- Manages time and resources efficiently and effectively
- Maintains effective working relationships with our callers and co-workers; always ethical, professional, courteous, and nice
- Participates as a Team Member to ensure the smooth operation of the entire department
- References internal and external proprietary systems to obtain claim and eligibility information
- Maintains and enters notes with details and accuracy on call log tracking application
- Answers a minimum average of 50 calls per shift
- Utilizes internal databases to provide efficient and effective information
- Analyzes claim and eligibility information in the LuminX system
- Handles competently all calls including those relating to potential stop loss issues, TPL issues and high dollar claims
- Assesses and handle challenging callers and/or any other calls which may need to be escalated to the manager. In the case of the manager’s absence, report to the customer service team lead
- Complies with company policies and procedures
- Complies with department policies and procedures
- Performs special projects at the request of management
- Regular, predictable attendance is required.
- Ability to get along and work effectively with others
- Maintain up to date and thorough knowledge of employee benefit provisions for group health plans including medical, dental, vision and prescription drugs
- Answer questions concerning e-Payment, assist clients with navigating e-Payment portal, explain the advantages of receiving e-Payment
- Demonstrate excellent communication, troubleshooting, listening and problem-solving skills
- Ability to multi task and prioritize
- Utilize system programs appropriately
- Meet the performance standards established for the position in the areas of: quality, accuracy, production, participant satisfaction and attendance
Supervisory Responsibilities: This job has no supervisory duties.
Measures of Performance: The Customer Service Representative shall be considered to be performing in an acceptable manner when the following have been accomplished:
- Problem Solving – Identifies and resolves problems in a timely manner; Gathers and analyzes information skillfully; Develops alternative solutions; Works well in group problem solving situations; Uses reason even when dealing with emotional topics.
- Customer Service – Manages difficult or emotional customer situations; Responds promptly to customer needs; Solicits customer feedback to improve service; Responds to requests for service and assistance; Meets commitments.
- Interpersonal Skills – Focuses on solving conflict, not blaming; Maintains confidentiality; Listens to others without interrupting; Keeps emotions under control; Remains open to others' ideas and tries new things.
- Oral Communication – Speaks clearly and persuasively in positive or negative situations; Listens and gets clarification; Tailors the content of speech to the level and experience of the audience; Uses appropriate grammar and choice of words in oral speech; Organizes ideas clearly in oral speech; Responds well to questions; Demonstrates group presentation skills; Participates in meetings.
- Written Communication – Writes clearly and informatively; Edits work for spelling and grammar; Varies writing style to meet needs; Presents numerical data effectively; Able to read and interpret written information.
- Teamwork – Balances team and individual responsibilities; Exhibits objectivity and openness to others' views; Gives and welcomes feedback; Contributes to building a positive team spirit; Puts success of team above own interests; Able to build morale and group commitments to goals and objectives; Supports everyone's efforts to succeed; Listens and responds constructively to other team members’ ideas; Offers support for others’ ideas and proposals; Is open with other team members about his/her concerns; Expresses disagreement constructively.
- Quality Management – Looks for ways to improve and promote quality; Demonstrates accuracy and thoroughness.
- Ethics – Treats people with respect; Keeps commitments; Inspires the trust of others; Works with integrity and ethically; Upholds organizational values.
- Judgment – Displays willingness to make decisions; Exhibits sound and accurate judgment; Supports and explains reasoning for decisions; Includes appropriate people in decision-making process; Makes timely decisions.
- Quantity – Meets productivity standards; Completes work in timely manner; Strives to increase productivity; Works quickly.
- Attendance/Punctuality – Prone to maintain an exceptional attendance record. Is consistently at work and on time; Ensures work responsibilities are covered when absent; Arrives at meetings and appointments on time.
- Dependability – Follows instructions, responds to management direction; Takes responsibility for own actions; Keeps commitments; Commits to long hours of work when necessary to reach goals. Completes tasks on time or notifies appropriate person with an alternate plan.
Qualifications: To perform this job successfully, an individual must be able to perform each essential duty satisfactorily. The requirements listed below are representative of the knowledge, skill, and/or ability required. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions.
Education and/or Experience: High school diploma or general education degree (GED); or one to three years related experience and/or training; or equivalent combination of education and experience. Knowledge of LuminX system and Basic Health Insurance terminology a plus.
Language Skills: Ability to read and comprehend simple instructions, short correspondence and memos. Ability to write simple correspondence. Ability to effectively present information in one-on-one and small group situations to customers, clients, and other employees of the organization.
Mathematical Skills: Ability to add and subtract two digit numbers and to multiply and divide with 10's and 100's. Ability to perform these operations using units of American money and weight measurement, volume, and distance.
Reasoning Ability: Ability to apply common sense understanding to carry out detailed but uninvolved written or oral instructions. Ability to deal with problems involving a few concrete variables in standardized situations.
Computer Skills: To perform this job successfully, an individual should have knowledge of Internet software and the Microsoft Office Suite of products. Knowledge of basic office equipment should include: Internet and email, copy and fax machines, postage meter and telephone.
Certificates, Licenses, Registrations: N/A
Physical and Emotional Demands: The physical demands 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 individuals with disabilities to perform the essential functions. The inability to cope with a stressful work environment does not constitute a protected disability.
While performing the duties of this job, the employee is frequently required to sit. The employee is regularly required to stand; walk; use hands to finger, handle, or feel; reach with hands and arms; climb or balance; stoop, kneel, and talk or hear. The employee must occasionally lift and/or move up to 10 pounds. Specific vision abilities required by this job include close vision, distance vision, and ability to adjust focus.
Work Environment: The work environment characteristics described here are representative of those an employee encounters while performing the essential functions of this job. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions.
The noise level in the work environment is usually very quiet.
Equal Employment Opportunity Policy Statement: Lucent Health Solutions, Inc. is an Equal Opportunity Employer that does not discriminate based on actual or perceived race, creed, color, religion, alienage or national origin, ancestry, citizenship status, age, disability or handicap, sex, marital status, veteran status, sexual orientation, genetic information, gender identity, gender expression, transgender status, arrest record, or any other characteristic protected by applicable federal, state or local laws. Our management team is dedicated to this policy with respect to recruitment, hiring, placement, promotion, transfer, training, compensation, benefits, employee activities and general treatment during employment.