Customer Service Representative II - Remote (Must live in CO)

Kaiser Permanente is seeking a Customer Service Representative II to enhance customer satisfaction and retention by providing accurate and timely information to members, customers, patients, and providers. The role involves handling complex inquiries, supporting members with their needs, and ensuring compliance with organizational guidelines.

Responsibilities:

• Available to handle member inquiries regarding:
• Member Core: Facility Inquiry, Web Support, Promote KP.Org, Order ID Card, Complaint, ID Card Inquiry, Service Review
• Member Advance: Eligibility Inquiry, Benefit Inquiry, General, Complaint, Correspondence Inquiry
• Add/Remove Dependent, Service Review, New Member Experience, Internal Regional Request, IVR Defaults
• Medicare (For up to two (2) regions.)
• Premium Billing Enterprise: Billing Inquiry, Make Payment, Complaint, EFT Inquiry, General Reinstatement Request, Service Review
• KPC Billing 1095 Tax Form, SLP* (escalations to Tier 3)
• Service Billing: Billing Inquiry, Make Payments, Complaints, Payment Plan, General, Service Review
• Claims: Claim Inquiry, Claim Referral Inquiry, Complaint, General, Provider Demographic Update, Service Review
• PSNAP: Post Stabilization Notification and Authorization Project
• Concierge
• Represents Health Plan by answering and documenting all incoming contacts to determine their nature and to respond to complex calls related to specialized product lines or queues
• Responds professionally to inquiries from internal/external customers
• Initiates contact with the appropriate Health Plan, medical group and facility personnel to obtain information relevant to the concern or inquiry as needed
• Evaluates data to determine and implement the appropriate course of action to resolve the complaint and/or coordinate service recovery
• Documents conversations with members according to procedure
• Follows established procedures to meet customer/member needs
• Required to effectively interact with diverse work units and relevant organizational departments
• Has substantial understanding of the assigned skills and applies knowledge and skills to complete a wide range of tasks
• Ability to understand relevant policies, processes and customers
• Assist the department in meeting customer needs and reaching department expectations
• Completes required training and understand how to use tools available to recall necessary information
• Develop a full awareness of the way performance and actions affect members and Member Service Contact Centers (MSCC) performance guarantees (call handling, first call resolution, complaint resolution compliance, member retention, and return contact as warranted)
• Promotes, ensures and provides customer service to internal/external customers by demonstrating skills which are consistent with the organizations philosophy of providing extraordinary customer relations and quality service
• Consistently supports compliance and the Principles of Responsibility (Kaiser Permanentes Code of Conduct) by maintains the privacy and confidentiality of information, and protects the assets of the organization
• Performs other relevant duties as required

Requirements:

• Minimum two-and-a-half (2.5) years of customer service experience to include six (6) months as a Customer Service Representative I within the Member Service Contact Center shared service
• High School Diploma OR General Education Diploma (GED) required
• Must pass department administered Tier II Assessment with minimum score of 70%
• Must pass knowledge checks while in training
• Excellent written and verbal communication skills
• Demonstrated analytical and problem-solving skills
• Strong knowledge of systems used within the MSCC
• Ability to read and respond briefly, clearly and effectively
• Ability to think critically and problem solve
• Ability to manage own work with minimal direction