Customer Service Representative

• Focused on proactively resolving our members and/or providers questions and concerns using computer-based resources to find answers.
• Guide members and providers with their healthcare needs by explaining benefits, solving claim concerns, helping find a doctor via telephone calls, online chats, or e-mails.
• Partner internally to create a seamless experience for our customers and resolve potential issues.
• Provide guidance and support to users on how to use the beacon app effectively and efficiently.
• Answer incoming phone calls from patients and 3rd party vendors to identify the type of assistance the caller needs.
• Focus on resolving issues on the first call, navigating through complex computer systems to identify the status of the issue and provide appropriate response to caller.
• Deliver information and answer questions in a positive manner to facilitate strong relationships with clients’ customers.
• Complete the documentation necessary to track provider issues and facilitate the reporting of overall trends.
• Interact with providers with the intent to develop a relationship with them. Within a high-volume setting, you’ll need to develop knowledge of our various products and multiple levels of benefits within each product to best assist our providers/customers.

• Servicing customers with professionalism and consideration for the customer’s requests or concerns.
• Obtaining detailed, technical information from claimants to establish and process unemployment insurance claims, and to detect potentially disqualifying unemployment insurance issues.
• Provide guidance and support to users on how to use the beacon app effectively and efficiently.
• Respond to user enquiries via email and chat in a timely and professional manner.
• Adjudicate potentially disqualifying Unemployment Insurance (UI) issues in accordance with established guidelines to provide high quality customer focused services that regulate the distribution of unemployment insurance benefits to support the economic stability of the state.
• Responsible for the maintenance and updating of claimant problem resolution documentation of claimant log and submitting certifications for payments when necessary.
• Actively solve problems and innovate on behalf of the customer.
• Call, empathize and resolve claimant issues regarding their benefits.
• Perform fraud review in claimants accounts and documents.
• Verify every claimant to make sure no trace of fraud existed in an account by going through driver’s license, passport, social security cards and more.
• Assist with, manage and be responsible for escalated claims while providing exceptional customer service.
• Updating customer information as required. Maintaining confidentiality of information. Performing other duties as the need arises
• Receive and solve incidents related to job requirements.
• Provide exceptional customer service in all aspects of my role.
• Communicate well within the team and across the company.
• Daily use of Landline phone or cell phone
• Contribute to the development and implementation of customer support processes and procedures.