Customer Services Specialist (Hybrid - Troy, MI) - Health Alliance Plan

General Summary

This position has the following primary objectives with respect to customer relations for all HAP product lines: (1) Provide follow-up and courteous and prompt resolution to internal and external customer inquiries by conducting thorough investigations and fully educating customers; (2) Support corporate and departmental goals, member enrollment activities and product implementations; (3) Research, investigate and resolve service failures. Improve the customer experience by identifying root causes, trends and recommend resolutions for service recovery and retention; (4) Educate internal and external customers and prospective members to promote HAP as the health care coverage of choice.

Principal Duties And Responsibilities

• Respond to inquiries by telephone (inbound and outbound), mail and in person; research and answer inquiries, complaints and appeals by following all department standards, policies and procedures; direct inquiries to supporting departments for appropriate action and resolution.
• Educate internal and external customers and potential members on policies, procedures, product offerings, benefit plan and coverage provisions related to all HAP products.
• Document all incoming inquiries accurately to track member inquiry history and trends.
• Practice and maintain confidentiality to Privacy and HIPAA regulations. Proactively seek training and development to enhance skills and abilities.
• Monitor workflow inbox and outstanding cases to ensure that all inquiries receive an appropriate response in a timely manner; Contact internal/external customers (by phone/or in writing), as needed, to ensure timely resolution and follow-up to inquiry.
• Interact with support departments in a professional manner to ensure internal and external customer needs are met. Develop and maintain strong business relationships with inter- departments; Continue to self-educate on changes in policies and procedures that occur in other departments which could have an impact on department operations and the servicing of customers.
• Attend training and development sessions or continuing education opportunities offered by Customer Service and maintain enhanced skill levels and performance.
• Interact with providers and their staff to obtain information for resolving customer inquiries/complaints.
• Ensure and maintain compliance of all department and corporate standards, policies and procedures.
• Recommend process improvements based on observations and trends identified while interacting with internal and external customers.
• Coordinate and assist with various departmental projects, member enrollment periods, outreach activities and corporate initiatives.
• Perform other related duties as assigned.
  
  

Education/Experience Required

• Associate degree or a minimum of four (4) years of recent and related work experience in a customer service capacity may be considered in lieu of the degree.
• Course in Medical Terminology (required completion within six months post- employment) or two (2) years prior experience in the health care or health insurance field will be accepted in lieu of the medical technology course requirement.
• Minimum of two (2) years of recent Customer Service or Call Center experience.
  
  

Skills And Abilities

• Must be dependable.
• Demonstrate a high degree of integrity, patience, maturity, empathy, tact and diplomacy.
• Demonstrate problem solving skills, flexibility, good judgment and ability to provide service excellence.
• Demonstrate the ability to handle assigned projects from start to successful completion including appropriate follow-up and documentation.
• Demonstrate the ability to handle multiple priorities concurrently in a timely and accurate manner.
• Demonstrate strong interpersonal, listening, verbal communication and business writing skills.
• Demonstrate efficiency in using a PC and various Microsoft programs.
• Fundamental understanding of HMO/PPO/POS delivery system and claims billing.
• Must be able to work flexible shifts, overtime including evenings and weekends as requested and/or scheduled.
  
  

Additional Information

• Organization: HAP (Health Alliance Plan)
• Department: Customer Service
• Shift: Day Job
• Union Code: Office/Non-Exempt, HAP