Customer Service Representative

Description & Requirements

• Essential Duties and Responsibilities: - Answer incoming customer inquiries received via telephone, Interactive Voice Response (IVR), web chat functions, or other approved contact channels in accordance with performance standards, policies, procedures, and confidentiality and privacy requirements. - Provide accurate information regarding programs and services to consumers, prospective enrollees, individuals acting on behalf of enrollees, health plans, and providers. - Track, document, and record all customer interactions, inquiries, complaints, comments, actions taken, and transactions in applicable systems. - Complete associated tasks and transactions according to established guidelines to ensure accuracy and completeness. - Navigate multiple computer systems while interacting with customers and perform data entry accurately. - Facilitate fulfillment of customer requests for materials via mail, email, or electronic delivery as appropriate. - Transfer or refer customers to appropriate internal or external entities in accordance with established guidelines. - Address customer inquiries and resolve routine issues to ensure appropriate actions or updates are completed. - Escalate unresolved, complex, or sensitive issues or grievances to designated staff or departments for further investigation or resolution as needed. - Facilitate translation or interpretation services for non English speaking customers according to procedures. - Communicate with supervisors regarding potential needs, concerns, or issues impacting service delivery. - Meet Quality Assurance (QA), productivity, and other key performance metrics. - Attend required meetings and trainings and maintain up to date knowledge of all programs, systems, policies, and procedures. - Perform other related duties as assigned by management.