Customer Service Representative
Company: Sentara Health
Location: Miami
Posted on: October 7, 2024
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Job Description:
City/State
Doral, FL
Overview
Work Shift
Second (Evenings) (United States of America)
AvMed, a division of Sentara Health Plans in the Florida market, is
hiring a Member Engagement Representative. This is a 100% remote
position however candidates must reside in Miami Dade or Broward
County. First 90 days will be 100% onsite in our Doral office. Must
be able to work a flexible schedule including weekends.
Job Scope: AvMed is committed to helping members become educated
health care consumers. The Member Engagement Representative (MER)
provides a high-quality level of customer service to plan members
by answering complex benefit & enrollment questions, resolving
issues, and providing education in a continuous call volume
atmosphere. MERs complete the intake of grievances and appeals as
necessary ensuring that all concerns are responded to and resolved
appropriately with first call resolution whenever possible. MERs
must maintain confidentiality according to regulatory requirements
and are required to achieve a mastery level of knowledge and
understanding of the entire suite of AvMed member plans. If we have
a choice to use the AvMed Job Scope use it and not the Sentara job
scope.
Essential Job Functions:
--- Provides exceptional service to plan members via telephone by
ensuring that appropriate actions are taken to answer inquiries and
resolve problems/concerns in a timely and courteous manner. Serves
as the first point of contact for plan members and attempts to
achieve First Call Resolution on each call, through communication
and collaboration with internal departments.
--- Receives and professionally responds to member, agent, and
broker inquiries both verbally and in writing. Inquires may include
but are not limited to, processing policy changes, taking payments,
enrollment discrepancies, billing questions, PCP changes and
demographic updates. Ensures all relevant information is obtained
to handle inquiries and grievances using required resources. In
addition, properly documents with relevant details, actions taken,
resolution and properly categorizes member interactions in
designated software applications.
--- Identifies and escalates priority issues reporting to
department chain of command ensuring follow up to complicated
customer calls when required. "Keeps the Commitment"- by ensuring
proper follow up and follow through is done with the member as
committed to during the interaction.
--- Adheres to all regulatory requirements related to member
confidentiality, case documentation, quality, and inquiry response
times.
--- Masters' productivity and quality standards according to
individual and department goals. Focuses on achieving departmental
and organizational objectives.
--- Performs additional duties and responsibilities as assigned by
management
Minimum Requirements:
--- HS Diploma/GED
--- Ability to work in a fast-paced contact center handling
incoming calls pertaining to payment resolution and patient
inquiries.
--- Must possess good listening skills and be able to communicate
verbally with callers in a clear, concise, and professional
manner.
--- A total of one year of experience across one or more of the
following areas: healthcare setting billing or resolving insurance
accounts receivable, adjudicating insurance claims, pre-registering
or registering patients for healthcare services, handling inbound
calls in a customer service call center, or providing customer
service to the general public in a non-healthcare setting.
Preferred Requirements:
--- Fast and accurate typing skills, 35 wpm minimum
--- Bilingual in Spanish
--- Excellent verbal and written communication skills
--- Strong interpersonal and rapport building skills
--- Strong customer service skills and professional phone voice
--- Ability to problem solve, troubleshoot, and resolve issues in a
courteous manner
--- Ability to practice attentive and active listening
--- Ability to clearly and concisely summarize and document issues
while talking to callers
--- Ability to multitask and manage several software applications
at one time
--- Ability to function well under pressure while contributing to a
supportive work team
--- Ability to comprehend medical terminology and knowledge of
company products
--- Proficient with Microsoft computers applications
--- Basic knowledge of call center systems
--- Must be able to consistently meet or exceed the established
metrics for this position
--- Must be able to comply with department and company policies and
procedures including but not limited to attendance adherence and
punctuality
Our Benefits:
As the third-largest employer in Virginia, Sentara Health was named
by Forbes Magazine as one of America's best large employers. We
offer a variety of amenities to our employees, including, but not
limited to:
--- Medical, Dental, and Vision Insurance
--- Paid Annual Leave, Sick Leave
--- Flexible Spending Accounts
--- Retirement funds with matching contribution
--- Supplemental insurance policies, including legal, Life
Insurance and AD&D among others
--- Work Perks program including discounted movie and theme park
tickets among other great deals
--- Opportunities for further advancement within our
organization
Sentara employees strive to make our communities healthier places
to live. We're setting the standard for medical excellence within a
vibrant, creative, and highly productive workplace. For information
about our employee benefits, please visit: Benefits - Sentara
(sentaracareers.com)
Join our team! We are committed to quality healthcare, improving
health every day, and provide the opportunity for training,
development, and growth!
Note: Sentara Healthcare offers employees comprehensive health care
and retirement benefits designed with you and your family's
well-being in mind. Our benefits packages are designed to change
with you by meeting your needs now and anticipating what comes
next. You have a variety of options for medical, dental and vision
insurance, life insurance, disability, and voluntary benefits as
well as Paid Time Off in the form of sick time, vacation time and
paid parental leave. Team Members have the opportunity to earn an
annual flat amount Bonus payment if established system and employee
eligibility criteria is met.
Keywords: Talroo-health Plan, #Indeed, Health Plan, Customer
Service, Call Center
Job Summary
Responsible for all areas of customer service as it pertains to
research and resolution of telephone inquiries related to Plan
prescription benefits, eligibility or claim payment issues.
Primarily responsible for handling incoming calls to effectively
address eligibility, claim, and payment issues or to address and
perform patient scheduling and referral work. Provide quality
service and customer satisfaction through effective communication
and education.
Pre-employment screening required.
Qualifications:
HS - High School Grad or Equivalent (Required)
Customer Service, Data Entry
Skills
Sentara Healthcare prides itself on the diversity and inclusiveness
of its close to an almost 30,000-member workforce. Diversity,
inclusion, and belonging is a guiding principle of the organization
to ensure its workforce reflects the communities it serves.
Per Clinical Laboratory Improvement Amendments (CLIA), some
clinical environments require proof of education; these regulations
are posted at ecfr.gov for further information. In an effort to
expedite this verification requirement, we encourage you to upload
your diploma or transcript at time of application.
In support of our mission "to improve health every day," this is a
tobacco-free environment.
Keywords: Sentara Health, Key Biscayne , Customer Service Representative, Hospitality & Tourism , Miami, Florida
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