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Customer Service Representative ll

Primary Location Fulton, Maryland Job Number 1022808 Date posted 03/14/2022
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The Customer Service 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 support to members with an increased level of complexity in 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.

Essential Responsibilities:

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 Adv.: 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)

  • Service Billing: Billing Inquiry, Make Payments, Complaints, Payment Plan, General, Service Review

  • Claims: Claim Inquiry, Claim Referral Inquiry, Complaint, General, Provider Demographic Update. Service Review.

  • PSNAP - Post Stabilization Notification and Authorization Project

  • Concierge

  • 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.

  • 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.

  • Documents 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.

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

  • Promotes, ensures and provides customer service to internal/external customers by demonstrating skills which are consistent with the organization's philosophy of providing extraordinary customer relations and quality service.

  • Consistently supports compliance and the Principles of Responsibility (Kaiser Permanente's Code of Conduct) by maintains the privacy and confidentiality of information, and protects the assets of the organization.

  • Performs other relevant duties as required.

  • Shifts will include: Sun 10a-6:30p, M, T, off Wed, Th, F 12;30p-9p; Sun 10a-6:30p, M, T, W, off Th, F 12;30p-9p; and M-F 12:30p-9p


    Basic Qualifications:



    • Minimum two-and-a-half (2 1/2) years of customer service experience.


    • High School Diploma or equivalent (GED).

    License, Certification, Registration

    • N/A


    Additional Requirements:

    • Must pass Classification Assessment

    • Minimum typing speed of 30 WPM (Typing test must be current within one (1) year of the posting period.

    • Excellent written and verbal communication skills.

    • Demonstrated analytical and problem-solving skills.

    • Strong knowledge of systems used within the MSCC.

    • Ability to read and respond briefly, clearly and effectively.

    • Ability to think critically and problem solve.

    • Manage own work with minimal direction.

    • Must pass knowledge checks while in training.


    Preferred Qualifications:

    • six (6) months as a Customer Service Representative I within the Member Service Contact Center shared service

    Primary Location: Maryland,Fulton,Maple Lawn Call Center Scheduled Weekly Hours: 40 Shift: Day Workdays: Sun, Mon, Tue, Wed, Thu, Fri Working Hours Start: 10:00 AM Working Hours End: 09:00 PM Job Schedule: Full-time Job Type: Standard Employee Status: Regular Employee Group/Union Affiliation: M40|OPEIU|Local 2 Job Level: Individual Contributor Department: CSC Maple Lawn - Contact Center-Maple Lawn - 0315 Travel: No Kaiser Permanente is an equal opportunity employer committed to a diverse and inclusive workforce. Applicants will receive consideration for employment without regard to race, color, religion, sex (including pregnancy), age, sexual orientation, national origin, marital status, parental status, ancestry, disability, gender identity, veteran status, genetic information, other distinguishing characteristics of diversity and inclusion, or any other protected status.