Customer Service Representative I

The Customer Services Representative is responsible for increasing customer satisfaction and retention by providing members, customers, patients and providers with accurate, consistent, timely, and meaningful information. They will provide higher level support to members inquiries and issues as they utilize the KP Plan and provider services, continuing to build rapport and collaborative relationships with current and prospective members in accordance with compliance guidelines.

• Available to handle member inquiries regarding:




• Member Core:Facility Inquiry, Web Support, Promote KP. Org, Order ID Card, Complaint, ID Card Inquiry, Service Review.


• Member Advance:Eligibility Inquiry, Benefit Inquiry, General, Complaint, Correspondence Inquiry, Add/Remove Dependent, Service Review, New Member Experience, Internal Regional Request, IVR Defaults.


• Medicare:(For up to two (2) regions)


• Premium Billing Enterprise:Billing Inquiry, Make Payment, Complaint, EFT Inquiry, General, Reinstatement Request, Service Review.


• KPC Billing, 1095 Tax Form, SLP* (escalations to Tier 3).


• Represents Health Plan by answering and documenting all incoming contacts to determine their nature and to respond to complex calls related to specialized product lines or queues.


• Responds professionally to inquiries from internal/external customers. Promotes, ensures and provides customer service to internal/external customers by demonstrating skills which are consistent with the organizations philosophy of providing extraordinary customer relations and quality service.


• Initiates contact with the appropriate Health Plan, medical group and facility personnel to obtain information relevant to the concern or inquiry as needed.


• Evaluates data to determine and implement the appropriate course of action to resolve the complaint and/or coordinate service recovery.


• Develop a full awareness of the way performance and actions affect members and Member Service. Contact Centers (MSCC) performance guarantees (call handling, first call resolution, complaint resolution compliance, member retention, and return contact as warranted).


• Consistently supports compliance and the Principles of Responsibility (Kaiser Permanentes Code of Conduct) by maintaining the privacy and confidentiality of information, and protects the assets of the organization.


• Performs other relevant duties as required.


• Documents conversations with members according to procedure.


• Follows established procedures to meet customer/member needs.


• Required to effectively interact with diverse work units and relevant organizational departments.


• Has substantial understanding of the assigned skills and applies knowledge and skills to complete a wide range of tasks.


• Ability to understand relevant policies, processes and customers.


• Assist the department in meeting customer needs and reaching department expectations.


• Completes required training and understand how to use tools available to recall necessary information.