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Customer Service Representative(Call Center)/Member Level Processor

Expired Job

Esolutions Inc Lodi , CA 95240

Posted 4 months ago

Position:1-Customer Service Representative/ Call Center
Position:2-Member Level Processor
Location: Lodi, CA,95240

Position :1---Customer Service Representative/ Call Center
Job Description
Day to Day Responsibilities of this Position and Description of Project:
Responds to and resolves various customer inquiries via telephone and correspondence and resolves various problems within established production and quality standards. Answers incoming calls and written requests for information from members or Brokers promptly and accurately. Composes routine and non-routine correspondence to answer Producer inquiries that require a written response.
Coordinates with other departments to ensure timely and appropriate responses. Expedites and resolves complex issues. Educates others on the Blue Shield product, providing accurate information and updates to policies and procedures, improving overall customer satisfaction in the process.
In the Lead role, deals with the most complex cases and issues as an individual contributor or may focus on mentoring and acting as a backup for supervisory responsibilities. May assist in scheduling and coordinating team activities. Typically provides input in hiring decisions and performance appraisals.
Handles the highest level of escalated and unresolved calls

Successfully exceed Associate level responsibilities. In addition,

Successfully completes tier 2 training which covers some of the following:
Handles escalated calls; may de-escalate calls
Responds to member benefits in writing
Peer to peer coaching /training
Performs inventory reduction, routine to mid-level, (i.e. member inquiries, may adjust claims, responds to emails, etc.)
May expedite, research, and resolve complex issues
Consistently performs established performance metrics, such as quality, production; average handling time (AHT) and calls per hour (CPH)
Works with minimal supervision

Successfully meets requirements of nesting audit
Have strong customer service experience (especially phones) and a proven ability to meet performance standards
Strong organizational skills
Ability to work independently
Ability to mentor others
Ability to interpret the various health plans and any documentation associated with them

Must Have
1.Contact center experience preferred
2.Microsoft office products
3.Call Center

Position:2 Member Level Processor Intermediate
Job Description
Job Title:
Customer Service & Operations - Member Level Processor Intermediate
Day to Day Responsibilities of this Position and Description of Project:
The team this position is on consists of the Address Update Team and possibly some cross training with Medicare Supplement and Report Processing. The Address Update Team is a team that performs research on returned mail and member outreach to acquire valid mailing addresses.
The Medicare Supplement team focuses on ensuring all new members are enrolled correctly and working Pended applications. Report processing consists of reviewing existing errors on reports, researching members and determining what the enrollments should look like in our eligibility system.
Regularly contacts internal and external customers and business partners to verify or obtain additional information to complete processing work and verify member eligibility/data and/or address information
Uses daily reports to manage eligibility and/or addresses for IFP membership, Small & Large Group membership, Medicare Supplement membership as well as employer groups.
Makes recommendations to supervisor/management for improvements in work processes and task documentation
May act as mentor / chair side trainer to new team members
In addition must have good written and verbal communications skills.
Basic experience in Microsoft Excel, Word & Access
Basic understanding of end to end process
Must be flexible to assist with special projects pertaining to Address Update Team and possibly Medicare Supplement
Must be able to focus on attention to detail
Minimum Experience Level Typically requires a high school diploma or GED and 1-2 years related experience and/or training, or equivalent combination of education and experience

Must Have
1.Facets knowledge
2.Dedicated Team Player / Involved in Team Engagement
3.Phone etiquette
4.Strong Prioritization skills / adhere to Production Stnds
5.Microsoft Office (Access, Outlook, Excel must be proficient)

Warm Regards,
Neha Rathi
Talent Acquisition
Vidhwan Inc. DBA E-Solutions- E-Verified Employer
2 N. Market St., #400, San Jose, CA, 95113
Tel (US): Fax:

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Customer Service Representative(Call Center)/Member Level Processor

Expired Job

Esolutions Inc