Customer Service/Call Center Specialist - Health Alliance Plan

This position has the following primary objectives with respect to customer relations for all HAP product lines:

• Provide follow-up and courteous and prompt resolution to internal and external customer inquiries by conducting thorough investigations and fully educating customers.
• Support corporate and departmental goals, member enrollment activities and product implementations.
• Research, investigate and resolve service failures. Improve the customer experience by identifying root causes, trends and recommend resolutions for service recovery and retention.
• Educate internal and external customers and prospective members to promote HAP as the health care coverage of choice.

PRINCIPAL DUTIES AND RESPONSIBILITIES:

• Respond to inquiries by telephone (inbound and outbound), mail and in person; research and answer inquiries, complaints and appeals by following all department standards, policies and procedures; direct inquiries to supporting departments for appropriate action and resolution.
• Educate internal and external customers and potential members on policies, procedures, product offerings, benefit plan and coverage provisions related to all HAP products.
• Document all incoming inquiries accurately to track member inquiry history and trends.
• Practice and maintain confidentiality to Privacy and HIPAA regulations. Proactively seek training and development to enhance skills and abilities.
• Monitor workflow inbox and outstanding cases to ensure that all inquiries receive an appropriate response in a timely manner; Contact internal/external customers (by phone/or in writing), as needed, to ensure timely resolution and follow-up to inquiry.
• Interact with support departments in a professional manner to ensure internal and external customer needs are met. Develop and maintain strong business relationships with inter- departments; Continue to self-educate on changes in policies and procedures that occur in other departments which could have an impact on department operations and the servicing of customers.
• Attend training and development sessions or continuing education opportunities offered by Customer Service and maintain enhanced skill levels and performance.
• Interact with providers and their staff to obtain information for resolving customer inquiries/complaints.
• Ensure and maintain compliance of all department and corporate standards, policies and procedures.
• Recommend process improvements based on observations and trends identified while interacting with internal and external customers.
• Coordinate and assist with various departmental projects, member enrollment periods, outreach activities and corporate initiatives.