Job Description

*** Must Live in Tallahassee or Surrounding Area ***

***MUST HAVE***

• Need At Least 2 Years CSR Telephone Exp
• MS Word/Powerpoint Exp
• High School Diploma or GED
• Be able to pass a Federal Background Check

** Fully Remote Position **

• Training is 8wks, Mon-Fri 8am - 5pm EST
• Shift will be an 8-hour shift between Mon-Fri 8am - 8pm EST

Job Summary:

The Call Center Representative is a front-line service position aiding state benefit system members and providers regarding programs, policies, and procedures. Responsibilities include answering incoming calls related to eligibility, benefits, claims, and authorization of services from members or providers.

Responsibilities:

• Available to work scheduled work hours based on operational needs
• Accurately respond to inbound phone calls and processing provider and member inquiries
• Under general supervision, resolve customers' service or billing complaints by demonstrating sound judgement
• Contact customers to respond to complex inquiries or notify them of claim investigation results
• Refer unresolved customer grievances, appeals, and claim resolution to designated departments
• Keep records of customer interactions and transactions
• Actively listen and probe callers to determine the purpose of the calls
• Research and communicate information regarding member eligibility and claims status
• Assume responsibility for self-development and career progression
• Educate providers on how to submit claims and when/where to submit a treatment plan
• Perform necessary follow-up tasks to ensure member or provider needs are completely met.
• Support team members and participate in team activities

Must Have:

1. Experience with Microsoft Word and Powerpoint
2. 2 years of Call Center Experience
3. 1 year of Healthcare Experience

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