SUMMARY: The Call Center Representative is responsible for answering all incoming calls received in the Benefit Service Center. Calls will refer to requests, issues or cases pertaining benefit management for assigned accounts. The service entails assuring immediate resolution or follow-ups on a need basis until closure of inquiry.

Call Center Representatives provide quality service to every participant’s needs, by using effective tools to handle situations in a properly manner, with professionalism, empathy and genuine desire to serve our clients. Our main concern must be excellence in Customer Service and resolutions of situations presented in calls received in our Contact Center focusing on time management skills.

RESPONSIBILITIES:

• Be present, logged to the Soft Phone and available to receive calls by 7am.
• Have complete knowledge of the information that will be provided in every call.
• Responsible for reviewing accounts information periodically to have full knowledge of changes made by our clients regarding their benefits.
• Have complete knowledge of the computer systems available in order to access information to manage a phone call.
• Analyze and identify the clients’ needs in order to give a resolution utilizing time management skills.
• Be prepared to manage complaints with empathy and professionalism.
• Apply the proper telephone etiquette to satisfy various customers’ situations by identifying voice skills to enhance good telephone presentation.
• Document every call and transaction made to resolve the inquiry presented by the client, including being able to categorize the issue correctly.
• Provide Clients with documents to validate their benefits and eligibility upon their requests such as: certifications of coverage, formularies requested to evidence eligibility, reimbursements, cancellations, cobra bills, cobra inscription documents, HIPAA Letter, etc.
• Be willing to go the extra mile in resolving urgent situations such as: (prescriptions issues, eligibility issues when medical assistance is needed, cobra payments issues or health insurance payments issues, etc.), including transferring the call to the account manager for better assistance.
• Identify and escalate priority issues.

• Follow instructions when referring situations that require personalize assistance from the account manager by leaving in SysAid the ticket “Open” and assigned to the corresponding account manager.
• Provide follow up to a participant when necessary.

Customer Service Representative must complete all logs, additional tasks and calls reports requested by the due date established.

KNOWLEDGE, SKILLS, AND/OR ABILITY: To perform this job successfully, an individual must be able to perform each essential duty satisfactorily.

• Strong computer skills including proficiency with Microsoft Office applications (Outlook, Word, Excel, Power Point, etc.).

• Customer service oriented, Ability to build strong customer relationships.
• Analytical, planning and organizational skills.
• Excellent communication (verbal and writing) and interpersonal skills, Bilingual (English/Spanish).
• Strong sensitivity to confidentiality standards.
• Be able to initiate and follow through with independent projects.
• Ability to manage multiple tasks in same period.
• Must be detail oriented, extremely accurate, able to follow up on service inquiries until closure and engage in multiple projects and meet all deadlines.
• Strong inter-personal relationship skills and problem solving skills are required.
• Ability to explain complex procedures and concepts in a simple, concise manner.
• Incumbents in this position must have teamwork and team building skills.
• Meet the requirements of the organizations corporate values (Integrity, Teamwork, Value for Customers and Performance Driven).