Customer Service Representative I (Pacific/Mountain Time Zone Based)

Western Growers is seeking a Customer Service Representative I to handle customer inquiries regarding insurance benefits and claims. The role involves analyzing data, maintaining customer relations, and ensuring quality service while meeting performance metrics.

Responsibilities:

• Respond to general customer questions via telephone, e-mail, and written correspondence regarding insurance benefits, provider contracts, reimbursement programs, eligibility, and claims in a confidential, professional, and ethical manner
• Analyze problems and provide information/solutions
• Research and resolve aged Customer Service open calls within company standards
• Operate in the Health Care Processing System (HCPS), Imaging systems, and all systems necessary to obtain and extract information with proficiency and skills
• Develop and maintain positive customer relations and coordinate with various functions within the company to ensure customer requests and questions are handled appropriately and in a timely manner
• Be accountable when you uncover an issue or trend by helping to assess and report its impact, making improvements, and course-correcting along the way
• Follow quality guidelines to provide exceptional customer support and ensure scores meet or exceed expectations
• Accurately document database activity and customer interaction for tracking and analysis to identify trends and address operational and service issues
• Research and analyze data to address standard operational challenges and customer service issues
• Provide customers with requested information, including difficult and upset customers
• Meet or exceed all department and performance service metrics
• Communicate with the appropriate departments and identify service issues
• Identify inefficiencies within the established processes and suggest possible solutions to save time, reduce risk, and/or reduce expenses
• Maintain regular attendance per employee handbook guidelines
• Utilize all capabilities to satisfy one mission — to enhance the competitiveness and profitability of our members
• Do everything possible to help members succeed by being curious and striving to understand what others are trying to achieve, planning, and executing work helpfully and collaboratively
• Be willing to adjust efforts to ensure that work and attitude are helpful to others, be self-accountable, create a positive impact, and be diligent in delivering results
• Maintain internet speed of 40 MB download and 10 MB upload and router with wired Ethernet
• Maintain a HIPAA-compliant workstation and utilize appropriate security techniques to ensure HIPAA required protection of all confidential/protected client data
• Maintain and service safety equipment (e.g., smoke detector, fire extinguisher, first aid kit)
• All other duties as assigned

Requirements:

• High School diploma or GED
• One (1) to three (3) years of experience in customer service within a call center environment
• Good communication and telephone skills with a very clear and concise speaking voice
• Proficient written communication skills with the ability to learn new software and navigate multiple systems at once
• Moderate keyboarding skills including proficiency with database management
• Proficient organizational and time management skills
• Adaptive in constantly changing environment
• Skilled in researching and resolving standard technical issues or client problems as they arise
• Good judgement, negotiation abilities and capacity to work with minimal supervision
• Capable to learn and understand company's end-user software programs
• Ability to meet or exceed departmental service metrics
• Fluent in English (oral and written)
• Internet access provided by a cable or fiber provider with 40 MB download and 10 MB upload speeds
• Home router with wired Ethernet (wireless connections and hotspots are not permitted)
• A designated room for your office or steps taken to protect company information (e.g., facing computer towards wall, etc.)
• A functioning smoke detector, fire extinguisher, and first aid kit on site
• Knowledge of Health Benefits and eligibility
• Bilingual in Spanish