Daytona Employment is currently recruiting for Customer Service Reps for a company located in Daytona Beach.
The hours will be Monday - Friday - 8:00am-5:00pm
Skills: Computer and customer service experience, multi-lingual is a plus.
- High School Diploma required. A minimum of two (2) years of college is preferred.
- Excellent verbal and written communication skills required.
- Must be able to type a minimum of 30 wpm with 90% accuracy.
- Proficiency with Microsoft Word/Outlook and basic keyboarding skills required.
- Must be able to work independently and with others in a multi-disciplinary team environment.
- Strong problem solving, organizational and time management skills required.
- Two (2) years experience with a Managed Care Organization preferred.
- Two (2) years experience in the health care industry, preferably in public relations, Customer Service, or compliance/state and federal regulations preferred.
- Comprehensive understanding of Benefits and Patient Rights is preferred.
- Working knowledge of ICD-9 and CPT coding preferred.
- Must be able to diffuse difficult situations.
- Must be flexible in meeting the demands of all department operations.
- Must be capable of multitasking.
- Multilingual a plus.
The Customer Service Representative presents a positive image to members at all times. This position answers calls from members related to inquiries, complaints, grievances, and appeals. Must be able to quickly research benefits, information about expenses, document conversation in Correspondence Unit Tracking System, perform a warm transfer if needed, and answer emails when assigned. Information must be accurate and professionally delivered.
- Must receive calls, answering promptly, professionally, and courteously following the Division Policy and Procedure for Phone Etiquette.
- Respond appropriately to member complaints/inquiries.
- Correctly explain all inquiries regarding individual benefits package.
- Accurately determine reason for call.
- Documents calls in CUT system using appropriate codes, grammar and spelling.
- Ability to triage calls to appropriate person, staying on the line to ensure a live transfer whenever possible.
- Responds in a timely manner, not to exceed the State of Florida Statutes, Medicare Regulations, and Accreditation Standards.
- Act as a Member Advocate, while at the same time presenting and justifying the Organization's actions in relationship to the individual grievance.
- Work as a team to assure maximum coverage of the Department
- Attend training on new policies and procedures, product lines, CMS regulatory changes, State of Florida regulatory changes and equipment, and maintain documentation of the same.
- Accept contacts from various sources including, but not limited to, Members presenting in Department, telephone contact by Members and/or co-workers.
- Takes an active involvement in Performance Improvement.
- Identifies, intervenes, documents, and reports all potential quality/risk management issues.
- Works with the other Departments when identifying continuity of care issues on new members.
- Maintains electronic case files in the approved format.
- Adheres to company safety and hazardous materials policies.
- Is familiar with and adheres to the compliance plan, and all HIPAA regulations.
- Performs other job-related duties as directed.
- When assigned, answers emails within one business day.
- When assigned, answer Spanish member calls as needed.