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Job Summary

The Customer Service Representative (CSR) ensures final resolution of each customer inquiry in a timely and courteous manner while documenting detailed information relevant to the contact. Resolution may require system research and/or contacting experts in other areas of the company. Although some encounters may require multiple interactions, the CSR strives for the company goal of “first time resolution” whenever possible.

Requirements

EDUCATION

High school diploma or equivalent.

EXPERIENCE

Minimum two (2) years' experience in a specialized customer service environment. OR two (2) years' college coursework (at least 48 credit hours) plus one (1) year experience in a specialized customer service environment.

ESSENTIAL SKILLS & ABILITIES

Customer Resolutions

Multitasking

Active Listening

Keyboarding

Work Independently

Independent Thinking

Organized Detail Oriented

Written and Verbal Communications

Customer Service

Problem Solving

Working in a high stress environment

Computer Literacy

Must pass company proficiency test:  Customer Service Assessment

Skills

• Active Listening • Computer Literacy • Critical Thinking • Customer Service • Documentations • Evaluating Information • Oral Communications • Organizing • Problem Solving • Researching • Results Interpretation • Time Management • Written Communication

Responsibilities

• Communication: Communicates in a clear and concise manner (whether orally or in writing) using business English, correct grammar, and precise vocabulary; learns to make complex insurance topics accessible to a wide audience and explain benefits without resorting to jargon; develops the ability to listen, comprehend what is being said, and ask appropriate questions that help lead to issue resolution; and keeps accurate and complete electronic notes of conversations in the appropriate software systems. • Customer Service: Interacts directly with customers, which may include members, groups, and providers to resolve issues related to the products and services and health insurance plans offered by ABCBS and its family of companies; and completes interactions based on company standards and directives as well as within state and federal guidelines such as the privacy rules enumerated in HIPAA guidelines. • Other duties: As assigned • Problem-Solving/Complaint Resolution: Always conducts him/herself in a positive and professional manner, addressing others with politeness, etiquette, and tact; handles confrontational situations with empathy but also in such a manner as to reach fact-based objective conclusions and resolve; and gains conclusive agreement through negotiation. • Product Knowledge and System Know-How: Becomes an expert on benefits and eligibility for health insurance plans supported by multiple lines of business, as requested; and knows where and how to find information pertinent to providing superior customer service.

Certifications

Security Requirements

This position is identified as level three (3). This position must ensure the security and confidentiality of records and information to prevent substantial harm, embarrassment, inconvenience, or unfairness to any individual on whom information is maintained. The integrity of information must be maintained as outlined in the company Administrative Manual.

Segregation of Duties

Segregation of duties will be used to ensure that errors or irregularities are prevented or detected on a timely basis by employees in the normal course of business. This position must adhere to the segregation of duties guidelines in the Administrative Manual.

Employment Type

Regular

ADA Requirements

1.1 General Office Worker, Sedentary, Campus Travel - Someone who normally works in an office setting or remotely and routinely travels for work within walking distance of location of primary work assignment.