Job Summary:

The Customer Care Specialist I assists members or providers with routine service inquiries.;

Essential Functions:

• Resolve member or provider routine service inquiries; examples include claims processing, member benefit education, contracting and credentialing requests, eligibility inquiries, and transportation arrangements;
• Ensure all HIPAA and State requirements/regulations are always adhered to
• Research, follow up, and resolve all open/pending issues in a timely manner to ensure member or provider satisfaction
• Build and strengthen member or provider relationships by providing quality customer service.
• Maintain knowledge and understanding of all processes and procedures
• Adhere to all departmental and company policies and procedures
• Maintain complete and accurate documentation of all of telephone and written communications
• Act as a mentor to new hire employees
• Perform any other job related instructions, as requested

Education and Experience:

• High School Diploma or equivalent is required
• Two (2) years customer service experience is preferred
• Customer Service experience in a call center is preferred

Competencies, Knowledge and Skills:

• Critical thinking and listening skills
• Decision making and problem-solving skills
• Computer proficiency with knowledge and experience in a Windows environment
• Typing speed of 35 words per minute (WPM)
• Strong written and communication skills
• Works well under pressure
• Professional phone etiquette
• Proper use of grammar
• Ability to work in a fast-paced environment
• Adaptable to a constantly changing environment
• Attention to detail
• Ability to multitask
• Ability to work independently and with a team

Working Conditions:

• General office environment; may be required to sit or stand for extended periods of time
• Must adhere to an assigned daily work schedule and have predictable and reliable attendance