Job Description

Montage Health’s application process has changed effective 12/20/2019.
If you submitted an online application prior to 12/20/2019, you will be required to recreate your profile information if you want to apply to any new positions. You will no longer have access to your previously saved profiles and applications. Current employees applying for transfer into a posted position must also create a profile.

  • CHOMP has been voted the Best Place to Work in Monterey County for 10 straight years
  • Excellent Pay and Generous Benefits including a Pension and Continuing Education Reimbursement
  • Excellent Team Oriented Culture
  • Free Gym for Employees

Job Description:

Purpose of Position

The Customer Service Representative is responsible for answering telephone inquiries and responding to correspondence from clients, members and providers regarding eligibility, claims status and benefit determinations.

Responsibilities

  • Interacts with customers (client, member and provide) via telephone, email, or in person to provide support and information specific to eligibility, benefits, claims, prior authorization requirements and appeals.
  • Document all communication in the applicable system of record.
  • Provide proactive education to customers, as it relates to their specific inquiry.
  • Provide accurate and timely responses to all customer inquiries.
  • Successfully bring all issues to closure within appropriate timeframe.
  • Provide support and coverage to inter-departmental staff as needed.
  • Coordinate customer appeals and grievances with appropriate staff.
  • Perform other activities and functions as assigned.

Position Requirements

  • Excellent verbal and written communication skills, including active listening.
  • Working knowledge of customer service procedures and principles.
  • Service-oriented; Ability to resolve customer complaints and issues while maintaining a professional and calm demeanor.
  • Working knowledge of federal regulation specific to the administration of self-funded employer health and welfare plans, including ERISA, Department of Labor and Health and Human Services.
  • Working knowledge of coding, billing and medical terminology.
  • Ability to operate spreadsheet, word processing programs and computer equipment required to fulfill position responsibilities.
  • Exceptional diplomacy skills to effectively resolve issues under sometimes tense and stressful circumstances.
  • Readily adaptable to the changing needs of the business; able to manage multiple priorities; tolerance for ambiguity.
  • Ability to use sound judgement, identify next steps to be taken, and develop appropriate solutions.
  • Ability to collaborate with multiple parties to solve problems.

Competencies

  • Accountability and Dependability: Assumes responsibility for accomplishing duties in an effective and timely manner.
  • Integrity:  Consistently honors commitments and takes responsibility for actions and words.
  • Software and Computer Skills: Proficient in the use of Microsoft Office Suite, Highly skilled at using the Internet. Must learns effectively with computer-based and/or online training.
  • Flexibility:  Demonstrates adaptability and openness to alternative solutions and flexibility when interacting with others, understanding their attitudes, needs, interests, and perspectives.
  • Inclusiveness:  The ability to network and partner with all internal and external stakeholders including broad and diverse representation of private/public and traditional/non-traditional community organizations.

Skills and Education

  • Associates degree, or applicable professional experience, required.
  • Minimum 1 to 3 years experience in a healthcare or insurance industry call center.

Aspire Health Plan is an equal opportunity employer.

Assigned Work Hours:

Monday - Friday 8:00am to 5:00pm and possibility of additional shifts if coverage is needed.

Position Type:

Regular

Application Instructions

Please click on the link below to apply for this position. A new window will open and direct you to apply at our corporate careers page. We look forward to hearing from you!

Apply Online