Humera - Administrative and Professional Staffing

Health Care Customer Service Representative

Minneapolis, MN, United States
Contact For Rate
Jul 26, 2017
Jul 28, 2017
Job Type
Employment Status
Full Time
Health Care Customer Service Representative:
Humera has several positions available for Health Care Customer Service Representatives with our client in NE Minneapolis. This company is an independent, nonprofit that provides health coverage and services.  These are long-term contract opportunities.
This position is responsible for applying knowledge of our client's business, products, members and operations to accurately and effectively fulfill member service requests and inquiries. The position ensures adherence to policies and procedures and meet service level expectations by following established guidelines and standards. The person in this position should achieve fluency in at least one core product or service line.
  • Answer, resolve, track and document telephone calls from members, providers, internal departments, and external agencies, in a timely and professional manner. Research, resolve and communicate effectively with internal and external customers regarding member/provider concerns or issues. Educate members and external customers on policies and procedures related to members? health care program.
  • Research and resolve inquiries from internal /external customers including: Enrollment, eligibility, ID cards, clinic changes, demographic changes, benefit coverage, claims, payments, member reimbursement, and demonstrated knowledge of CAG policies, procedures, and regulations. Utilize appropriate resources to respond to member inquiries.
  • Answer, resolve, track and document telephone calls from members and providers in a timely and professional manner. Interpret member eligibility and coverage through thorough knowledge of the contracts, policies and procedures. Communicate with internal departments, members, providers and other customers regarding the transportation benefit in both verbal and written form, including faxing rides to providers at the appropriate times.
  • Identify trends/issues that emerge in calls/correspondence, and inform Team Lead or Supervisor. Assist in the development and communication of resolutions to internal staff, as requested.
  • Demonstrate and maintain a thorough and complete working knowledge of appropriate UCare information management systems, and ACD telephone system.
  • Maintain good working relationships and open communication with internal and external customers.
  • Attend department and other meetings as requested.
  • Other projects and duties as assigned.

Required :
  • One to two years call center experience or two years customer service experience.
  • Preference given to candidates with health insurance (HMO), physician group practice, or community agency.
  • Proficient PC skills required knowledge of Microsoft office preferred.
Preferred Experience:
  • Working knowledge of medical claims and/or medical billing processes is preferred.
  • Proficient computer skills; knowledge of Microsoft office, Amisys, and MACESS type software packages.
Education requirements:
  • High school graduate or the equivalent required. Two-year degree in health related, liberal arts or communication field, including a course in medical terminology is preferred.