Customer Service Rep PH

Corewell Health is a health system focused on improving health and serving patients, members, and communities. The Customer Service Representative will assist and educate health plan members, providers, employer groups, colleagues, and agents regarding benefits, claims, billing, eligibility, and related services while resolving complex inquiries and delivering an exceptional customer experience.

Responsibilities:

• Demonstrates high competency in analyzing, evaluating, and responding to complex service inquires from members, providers, employer groups, colleagues, agents, Elite agents, and different customer types across multiple Priority Health products within departmental guidelines. Professional and pleasant interactions are ongoing expectations
• Partnering with internal and external resources, promptly provides customers with information and education concerning benefit clarification, eligibility requirements, verification, authorization, billing and claim status
• Promptly identifies and resolves or escalates customer concerns or complaints to achieve positive outcomes. Places outbound welcome calls to members to educate them on their benefits as needed. Assists walk-in members and agents if assigned by leadership
• Adheres to established procedure and quality guidelines in support of Priority Health service promise, key drivers, performance indicators, as well as Corporate values and codes of excellence. Identifies potential trends or issues that impact health plan members and works with coworkers and leadership resources to suggest process improvements
• Assists customers with administrative issues, such as submitting enrollment record changes, providing letter explaining coverage or benefits, and obtaining and relaying certain member information to other departments as needed
• Facilitates claims resolution through follow-up on member calls and correspondence received to appropriate departments
• Effectively tracks and/or documents all service interactions with customers within appropriate systems according to guidelines
• Develops and maintains behaviors of productivity, availability to customers, and adherence to work schedule

Requirements:

• High School Diploma or equivalent
• 2 years of relevant experience customer-facing service on phone or face to face; customer service, high volume call center, medical billing, insurance environment relevant to benefits, provider contracting, claims processing, and/or managed health care
• Associate's Degree