Customer Service Specialist - Member Services
Houston, TX 77001
Efficiently and courteously respond to high-volume calls on multiple lines of businesses, from members, providers, and plan sponsor.
Interpret appropriate actions that will help resolve members, providers, and plan sponsors issues.
Document communications accurately and completely.
Interpret complex claims issues for adjustments and route to appropriate department for processing.
Identify accounts that are potentially Fraud Waste & Abuse issues and route to appropriate department for escalation.
Serve as a Subject Matter Expert and Peer to new Customer Service Representatives (Level I).
Respond to difficult and complex inquiries raised by internal or external Customer Service staff or other stakeholders such as brokers, groups, members, and providers.
Communicate, collaborate, and cooperate with internal and external stakeholders in a respectful and responsible manner to enhance relationships and render exceptional service.
Adhere to all Compliance/Program Integrity requirements.
Comply with HIPAA Regulations.