Customer Services Specialist (Hybrid - Troy, MI) - Health Alliance Plan
Job description
This position has the following primary objectives with respect to customer relations for all HAP product lines: (1) Provide follow-up and courteous and prompt resolution to internal and external customer inquiries by conducting thorough investigations and fully educating customers; (2) Support corporate and departmental goals, member enrollment activities and product implementations; (3) Research, investigate and resolve service failures. Improve the customer experience by identifying root causes, trends and recommend resolutions for service recovery and retention; (4) Educate internal and external customers and prospective members to promote HAP as the health care coverage of choice.
PRINCIPAL DUTIES AND RESPONSIBILITIES:
- Respond to inquiries by telephone (inbound and outbound), mail and in person; research and answer inquiries, complaints and appeals by following all department standards, policies and procedures; direct inquiries to supporting departments for appropriate action and resolution.
- Educate internal and external customers and potential members on policies, procedures, product offerings, benefit plan and coverage provisions related to all HAP products.
- Document all incoming inquiries accurately to track member inquiry history and trends.
- Practice and maintain confidentiality to Privacy and HIPAA regulations. Proactively seek training and development to enhance skills and abilities.
- Monitor workflow inbox and outstanding cases to ensure that all inquiries receive an appropriate response in a timely manner; Contact internal/external customers (by phone/or in writing), as needed, to ensure timely resolution and follow-up to inquiry.
- Interact with support departments in a professional manner to ensure internal and external customer needs are met. Develop and maintain strong business relationships with inter- departments; Continue to self-educate on changes in policies and procedures that occur in other departments which could have an impact on department operations and the servicing of customers.
- Attend training and development sessions or continuing education opportunities offered by Customer Service and maintain enhanced skill levels and performance.
- Interact with providers and their staff to obtain information for resolving customer inquiries/complaints.
- Ensure and maintain compliance of all department and corporate standards, policies and procedures.
- Recommend process improvements based on observations and trends identified while interacting with internal and external customers.
- Coordinate and assist with various departmental projects, member enrollment periods, outreach activities and corporate initiatives.
- Perform other related duties as assigned.
EDUCATION/EXPERIENCE REQUIRED:
- Associate degree or a minimum of four (4) years of recent and related work experience in a customer service capacity may be considered in lieu of the degree.
- Course in Medical Terminology (required completion within six months of post- employment.
- Minimum of two (2) years of recent Customer Service or Call Center experience.
CERTIFICATIONS/LICENSURES REQUIRED:
None
Skills and Abilities:
- Must be dependable.
- Demonstrate a high degree of integrity, patience, maturity, empathy, tact and diplomacy.
- Demonstrate problem solving skills, flexibility, good judgment and ability to provide service excellence.
- Demonstrate the ability to handle assigned projects from start to successful completion including appropriate follow-up and documentation.
- Demonstrate the ability to handle multiple priorities concurrently in a timely and accurate manner.
- Demonstrate strong interpersonal, listening, verbal communication and business writing skills.
- Demonstrate efficiency in using a PC and various Microsoft programs
- Fundamental understanding of HMO/PPO/POS delivery system and claims billing
- Must be able to work flexible shifts, overtime including evenings and weekends as requested and/or scheduled.
HFHS and HAP Team Member Standards of Excellence:
Must meet or exceed core customer service responsibilities, standards and behaviors as outlined in the HFHS’ Customer Service Policy and summarized below:
- Communication Ÿ Ownership
- Understanding Ÿ Motivation
- Sensitivity Ÿ Excellence
- Teamwork Ÿ Respect
Must practice the customer skills as provided through on-going training and in-services.
Must possess the following personal qualities:
- Be self-directed
- Be flexible and committed to the team concept
- Demonstrate teamwork, initiative and willingness to learn
- Be open to new learning experiences
- Accepts and respects diversity without judgment
- Demonstrates customer service values
PHYSICAL DEMANDS/WORKING CONDITIONS:
- Typical office environment
- Sedentary – Exerts up to 10 lbs. of force occasionally to lift, carry, push, pull, or otherwise move objects, including the human body. Involves sitting most of the time, but may involve walking or standing for periods of time.
- Talking – Expressing or exchanging ideas by means of the spoken word.
- Hearing – Perceiving the nature of sounds
- Travel – Minimal
Additional Details
This posting represents the major duties, responsibilities, and authorities of this job, and is not intended to be a complete list of all tasks and functions. It should be understood, therefore, that incumbents may be asked to perform job-related duties beyond those explicitly described above.
Overview
Under the leadership of President and CEO Robert G. Riney, Henry Ford Health is a
$6 billion integrated health system comprised of six hospitals, a health plan, and 250+ sites
including medical centers, walk-in and urgent care clinics, pharmacy, eye care facilities and
other healthcare retail. Established in 1915 by auto industry pioneer Henry Ford, the health system
now has 32,000 employees and remains home to the 1,900-member Henry Ford Medical Group, one
of the nation’s oldest physician groups. An additional 2,200 physicians are also affiliated with the
health system through the Henry Ford Physician Network. Henry Ford is also one of the region’s
major academic medical centers, receiving between $90-$100 million in annual research funding and
remaining Michigan’s fourth largest NIH-funded institution. Also an active participant in medical
education and training, the health system has trained nearly 40% of physicians currently practicing
in the state and also provides education and training for other health professionals including nurses,
pharmacists, radiology and respiratory technicians. visit HenryFord.com.
Benefits
Whether it's offering a new medical option, helping you make healthier lifestyle choices or
making the employee enrollment selection experience easier, it's all about choice. Henry
Ford Health has a new approach for its employee benefits program - My Choice
Rewards. My Choice Rewards is a program as diverse as the people it serves. There are
dozens of options for all of our employees including compensation, benefits, work/life balance
and learning - options that enhance your career and add value to your personal life. As an
employee you are provided access to Retirement Programs, an Employee Assistance Program
(Henry Ford Enhanced), Tuition Reimbursement, Paid Time Off, Employee Health and Wellness, and a whole host of other benefits and services. Employee's classified as contingent status are not eligible for benefits.
Equal Employment Opportunity/Affirmative Action Employer
Equal Employment Opportunity / Affirmative Action Employer Henry Ford Health is
committed to the hiring, advancement and fair treatment of all individuals without regard to
race, color, creed, religion, age, sex, national origin, disability, veteran status, size, height,
weight, marital status, family status, gender identity, sexual orientation, and genetic information,
or any other protected status in accordance with applicable federal and state laws.
gatheringourvoice.org is the go-to platform for job seekers looking for the best job postings from around the web. With a focus on quality, the platform guarantees that all job postings are from reliable sources and are up-to-date. It also offers a variety of tools to help users find the perfect job for them, such as searching by location and filtering by industry. Furthermore, gatheringourvoice.org provides helpful resources like resume tips and career advice to give job seekers an edge in their search. With its commitment to quality and user-friendliness, gatheringourvoice.org is the ideal place to find your next job.