Customer Service Representative

Title: Customer Service Representative

Location: US National

Your Future Evolves Here

Evolent Health has a bold mission to change the health of the nation by changing the way health care is delivered. Evolenteers make a difference wherever they are, whether it is at a medical center, in the office, or while working from home across 48 states. We empower you to work from where you work best, which makes juggling careers, families, and social lives so much easier. Through our recognition programs, we also highlight employees who live our values, give back to our communities each year, and are champions for bringing their whole selves to work each day. If you’re looking for a place where your work can be personally and professionally rewarding, don’t just join a company with a mission. Join a mission with a company behind it.

What You’ll Be Doing:

Put your customer service skills to work in a meaningful way! Evolent Health has MULTIPLE OPENINGS for Customer Service Representatives {Bilingual Spanish and English candidates highly encouraged} who are energetic, eager individuals ready to join a team dedicated to assisting our health plan customers and their families every day. This is a great opportunity if you have a dedication to service, thrive in a dynamic, fast-paced work environment and have a passion for providing outstanding care for the customers you connect with.

For this role we are seeking skilled and knowledgeable call center individuals who are comfortable interacting and providing support to health plan members, providers and/or their representatives, fluent in computer navigation and toggling while confidently and compassionately engaging with the caller. You’ll be rewarded and recognized for your performance in an environment that will challenge you and give you clear direction on what it takes to succeed in your role. Based on business need, we offer employees flexible work shift schedules, during our call center operating hours of 7:00 a.m. to 11:00 p.m., 7 days a week.

{For Bilingual candidates- **If you are bilingual in English & Spanish, we strongly encourage you to apply to join our team. Our diverse customer population has a large Spanish as a first or only language, and our bilingual representatives support our ability to immediately provide the support our customers need. Successful candidates who are qualified as bilingual in Spanish and English receive additional compensation for their language skill.}

What You’ll Be Doing:
Answer and manage inbound inquiries from customers in a prompt, courteous manner while documenting relevant information in a clear and concise manner in computer systems.
Ask appropriate questions and listen actively to identify specific questions or issues to provide appropriate response and type of assistance the customer needs.
Reply and handle inquiries via telephone and other communication channels, regarding health plan benefits and claims, eligibility, medical and other healthcare procedures, billing and payments and other related topics. Conduct out-bound and/or return calls to customers as necessary.
Analyze and own problem through to resolution on behalf of the customer in real time or through comprehensive and timely follow-up with the customer, providing accurate and complete information and solutions.
Communicate and partner with customers tactfully and empathetically to resolve issues, using clear language translating healthcare-related jargon and complex processes into simple, step-by-step instructions customers can comprehend and act upon.
Handle and process customer complaints/ grievances while applying appropriate conflict management skills to de-escalate potentially stressful situations.
Meet the performance goals established for the position in the areas of efficiency, accuracy, quality, member satisfaction and attendance. Adhere to all applicable department, organization and/or regulatory policies and procedures.
Read, comprehend and verbalize processes and procedures of the organization and of health insurance coverage.
o Training includes an online classroom with trainers who have experience working the Evolent CSO call center. Training Hours are usually 8:00 am 5:00 pm Monday Friday (during first 30 days of employment). Trainees will be required to maintain regular attendance at and successfully complete the required classroom training and demonstrate proficiency of the material at the end of training.

o Hours of Operation: 7 days a week, 7:00 am 11:00 pm (your shift will be determined after training)

PREFERRED EXPERIENCE WE LOOK FOR:
{Bilingual in Spanish & English validated via Language Qualification Assessment}
High school diploma or GED required
1 year call center experience
Ability to handle a heavy call volume of 50-100 calls daily
Demonstrated ability in using computer and Windows PC applications, which includes strong keyboard and navigation skills, ability to type 35 WPM and learn new computer programs
Ability to work regularly scheduled shifts within centers hours of operation including the training period, where lunches and breaks are scheduled, with the flexibility to adjust daily schedule, and work over-time and/or weekends, as needed
Demonstrated ability to quickly build rapport and respond to customers in a compassionate manner by identifying and exceeding customer expectations (responding in a positive, respectful, timely manner, consistently meeting commitments)
Demonstrated ability to take an educative approach, listen skillfully, collect relevant information, determine immediate requests and identify the current and future needs of the customer, answering questions and informing of health plan policies, procedures, or decisions.
Strong active listening skills, confident responsiveness that maintains the organization’s integrity.
Ability to maintain strict confidentiality of protected health information

This is a work from home position, which requires a quiet, private workspace without noise and distractions, and reliable internet connectivity provided through a wired connection with a minimum of 10 MBPS speed. A mobile or hot spot environment is not acceptable. You may need to purchase an Ethernet cord depending on your current Internet set up.

Associates degree or equivalent experience
1+ years at a health plan, TPA or related call center setting
Knowledge of managed care, Commercial, Marketplace, Medicaid and/or Medicare programs; knowledge of medical policy benefits and exclusions.

Technical Requirements:

Currently, Evolent employees work remotely temporarily due to COVID-19. As such, we require that all employees have the following technical capability at their home: High speed internet over 10 Mbps and, specifically for all call center employees, the ability to plug in directly to the home internet router. These at-home technical requirements are subject to change with any scheduled re-opening of our office locations.

Evolent Health is committed to the safety and wellbeing of all its employees, partners and patients and complies with all applicable local, state, and federal law regarding COVID health and vaccination requirements. Evolent expects all employees to also comply. We currently require all employees who may voluntarily return to our Evolent offices to be vaccinated and invite all employees regardless of vaccination status to remain working from home. Certain jobs require face-to-face interaction with our providers and patients in client facilities or homes. Employees working in such roles will be required to meet our vaccine requirements without exception or exemption.

Compensation Range: The minimum salary for this position is $, plus benefits. Salaries are determined by the skill set required for the position and commensurate with experience and may vary above and below the stated amounts.