JR-913599 Representative, Customer Service I - 11am - 9pm EST

Collaboration Opportunities:

• Customer Service Representatives (CSR’s) will be working with and providing support to health plan members, providers and/or their representatives. Leadership rewards and recognizes CSR’s regularly for performance in an environment that challenges while providing clear direction and support to foster success in the role.

What You Will Be Doing:

• Answer and manage inbound inquiries regarding health plan benefits and claims, eligibility, medical and other healthcare procedures, billing and payments and other related topics from customers in a prompt, courteous manner. Conduct out-bound and/or return calls to customers as necessary.
• Ask appropriate questions and listen actively to identify specific questions or issues to provide appropriate response and type of assistance the customer needs while documenting relevant information in a clear and concise manner in computer systems.
• Communicate and partner with customers tactfully and empathetically to resolve issues, using clear language translating healthcare-related jargon and complex processes into simple, step-by-step instructions customers can comprehend and act upon.
• Handle and process customer complaints/ grievances while applying appropriate conflict management skills to de-escalate potentially stressful situations.
• Meet the performance goals established for the position in the areas of efficiency, accuracy, quality, member satisfaction and attendance. Adhere to all applicable department, organization and/or regulatory policies and procedures.
• Read, comprehend, and verbalize processes and procedures of the organization and of health insurance coverage.
• Training includes a virtual classroom environment with trainers who have experience working within the Evolent Customer Service Operations (CSO) call center. Training Hours are 8:00am – 4:30pm CT Monday–Friday (for approximately 6-weeks). Trainees will be required to attend the entirety of training, successfully complete the required training schedule, and demonstrate proficiency of the material at the end of training.
• Hours of Operation: 6 days a week, 8:00am – 9:00pm ET (hours depend on the client to which you are assigned, and your shift will be determined during training if not before).

What You Bring:

• Bilingual in Spanish & English (validated via bilingual assessment upon offer acceptance) is a plus.
• At least 1 year call center experience is required.
• Ability to handle a heavy call volume of 50-100 calls daily.
• Demonstrated ability in using computer and Windows PC applications, which includes strong keyboard and navigation skills, ability to type 35 WPM and learn new computer programs.
• Ability to work regularly scheduled shifts within hours of operation including the training period, where lunches and breaks are scheduled, with the flexibility to adjust daily schedule, and work over-time and/or weekends, as needed.
• Demonstrated ability to take an educative approach, listen skillfully, collect relevant information, determine immediate requests and identify the current and future needs of the customer, answering questions and informing of health plan policies, procedures, or decisions.
• Ability to maintain strict confidentiality of protected health information.

• This is a work from home position, which requires a quiet, private workspace without noise and distractions, and reliable internet connectivity provided through a wired connection with a minimum of 100 MBPS speed. A mobile, hot spot, or WiFi connection is NOT acceptable.
• 2+ years at a health plan, TPA or related call center setting is a plus.
• Knowledge of managed care, Commercial, Marketplace, Medicaid and/or Medicare programs; knowledge of medical policy benefits and exclusions is a plus.