Customer Service Representative (CSR) is responsible for providing an enhanced customer experience for Dean Health Plan members, providers and group representatives. An excellent CSR will have general knowledge of the variety of Dean Health Plan products, benefits and provider networks in order to explain the effective use of benefit plans and benefits available to members and providers, and determine DHP's liabilities and obligations in varied medical circumstances. CSR is expected to utilize excellent communication and problem solving skills in order to resolve complex inquiries from internal and external customers. CSR must be customer-focused and motivated to implement ideal quality concepts with all callers including those who may be emotionally escalated. CSR will have the ability to work in a fast-paced, dynamic and technologically-based environment while having the ability to learn and implement new processes quickly. CSR will provide dependable and accurate results on a routine basis with close supervision and/or technical assistance. CSR must ensure compliance with department and regulatory requirements.
Essential Job Duties:
Educate and inform members about the benefits available under and the requirements of Dean Health's benefit plans and provide assistance by initiating and coordinating the exchange of information among members, providers, and other internal departments involved in the relevant processes over the telephone.
Instruct members how to receive maximum benefit reimbursement, including the advantages of utilizing their primary care physician and network providers.
Determine the various policy provisions, guidelines, providers, and provider requirements and procedures; medical review procedures; and the procedures of other Dean Health Plan departments that apply to the need or concern of the member.
Access and research various information databases to obtain knowledge to provide complete and accurate answers and make appropriate decisions about the caller's situation.
Provide complete and accurate information about Dean Health Plan's ongoing and changing plans and benefits in response to caller questions and concerns.
Accurately and completely document each phone call in accordance with the department's standards, monitor the types of inquires received, and report trends and concerns to the Management Team.
Stay abreast of related regulatory, compliance, and departmental updates to meet departmental metric requirements.
High school diploma or equivalent.
2 years of inbound call center or 2 years of customer service experience.
Strong verbal and written communication skills.
Proficient in Microsoft Office applications, with ability to easily toggle between systems and navigate through the Internet.
Ability to handle multiple tasks simultaneously, meet time sensitive deadlines, and organize workloads with general supervision.
High level attention to detail and customer service, with the ability to handle sensitive and confidential information.
Ability to work well in a team based environment.
General knowledge of insurance terminology, diagnostic and procedure codes.
Background in the health insurance industry, working in a clinic or billing office.
You’ve known us as many names throughout St. Louis, and now, we’re bringing our hospitals, doctors, home care and other services together under one name – SSM Health. With seven hospitals, 350+ physicians, more than 40 physician locations and 12,000 employees, we are part of something bigger and better. We’re connected to a wealth of resources, expertise and advance technology to help you, your fa...mily and our community live long, healthy lives.
We’ve grown and changed a lot over our 143-year history. Our name may be changing but our mission remains the same