Customer Service Specialist I
Navigating the Hiring Process
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Resolve complaints and inquires and provide information to members, prospective members, providers, other insurance carriers, agents and brokers, attorneys, employer groups and other member or provider representatives in writing, in person and over the telephone. Issues may be health plan related (e.g. medical coverage, claims, referrals, eligibility) or delivery system issues (e.g., appointment access, medical center service complaints, physician selection, fee quotes, patient billing issues) or governance issues (e.g., voting member information, consumer governance policies).
- Responds to health plan, delivery system, and governance inquiries and complaints in writing and over the telephone.
- Researches issues. Interact with other departments, physicians or administrators as needed. Resolve or escalate when appropriate.
- Identify errors and determine what corrective steps need to be taken to resolve.
- Interpret and apply all benefits according to appropriate contract.
- Document all interactions in contract tracking system according to regulatory guidelines.