Customer Service Associate – Remote
job requisition id
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Responsible for answering calls clearly and concisely, responding to questions, and providing guidance on transactions, inquiries, or complaints from both internal and external customers. Documents and resolves inquiries by using established best practices and educates members about available products and services, while adhering to compliance requirements and Centers for Medicare and Medicaid Services (CMS) standards.
- Responds to customer calls accurately and professionally including correct grammar and a friendly tone while also demonstrating a genuine delight to serve.
- Resolves customer service inquiries for 1-2 communities which could include benefit and eligibility information, billing and payment issues, customer material requests, physician assignments, authorization for treatment, and Explanation of Benefits (EOB).
- Handles escalated situations and acts urgently when necessary
- Makes outbound calls to members, providers, pharmacies, and/or hospitals etc. to resolve issues as needed.
- Investigates and responds to general inquiries while documenting in the system as appropriate.
- Interacts with other departments including Enrollment and Medical Management to resolve issues.
- Adheres to compliance requirements and CMS standards.
- Provides first call resolution for all customers.
- High School diploma, GED, or equivalent
- Familiarity with computer, Windows PC applications, and the ability to learn new and complex computer system applications
- Working knowledge of Microsoft Outlook, Word, Excel, and PowerPoint
- Solid verbal communication skills including the ability to speak to associates and customers at all levels
- Ability to be detail oriented and organized
- Strong investigative and problem-solving skills
- Ability to read, comprehend, and accurately follow instructions in a constantly changing environment
- Strong commitment to Service Excellence and delivering a customer service experience that results in a Five Star CMS rating.
- Ability to work flexible hours including weekends during part of the year as well as overtime when needed; Call Center is open 7a-10p CT and schedules will vary within that timeframe based on business need
- 6+ months of related experience
- Prior health care or insurance experience
- While performing the duties of this job, the employee works in normal office working conditions.
- The job description describes the general nature and level of work being performed by people assigned to this job and is not intended to be an exhaustive list of all responsibilities, duties and skills required. The physical activities, demands and working conditions represent those an employee encounters while performing the essential functions of this job. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential job duties and responsibilities.
Lumeris is an EEO/AA employer M/F/V/D.
The hiring range for this position is:
Factors that may be used to determine your actual pay rate include your specific skills, experience, qualifications, location, and comparison to other employees already in this role. This role may also be eligible for incentive compensation. At Lumeris, we are committed to providing a total rewards package that supports your overall well-being. Our benefits include medical, vision, dental, well-being programs, 401(k) with company matching, life insurance, paid time off including paid leave, and so much more. Learn more by visiting our Careers Page.
Lumeris and its partners are committed to protecting our high-risk members & prospects when conducting business in-person. All personnel who interact with at-risk members or prospects are required to have completed, at a minimum, the initial series of an approved COVID-19 vaccine. If this role has been identified as member-facing, proof of vaccination will be required as a condition of employment.