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Commercial Customer Service Representative

Job Description | Triton Health Systems, LLC.


Date Prepared: 4/26/2010 12:00:00 AM Reports To: Supervisor of Customer Service
Manager Approval: Department: Customer Service
HR Review: Status: Non-Exempt
Employee Signature: Revisions:
Job Summary Responsibilities include taking customer/provider calls, answering customer questions, resolving problems, educating members concerning their benefits. Trains, explains tasks, and assists in the solution of problems and on an ongoing basis, trains and assists in the solution of problems of other Customer Services Representatives.
Essential Functions
  • Assists members, employers, and providers with questions concerning eligibility, claims, referrals, general coverage questions and any questions concerning their health coverage with VIVA.
  • Creates accurate and timely member documentation concerning all phone calls taken.
  • Applies the Certificate of Coverage guidelines consistently.
  • Notifies members/providers of changes in the COC, procedure changes, provider changes, etc., in a timely manner.
  • Answers the phone within 2 rings.
  • Ensures understanding and adheres to company and departmental policies and procedures.
  • Meets or exceeds departmental goals established by the Supervisor and Manager of Customer Service.
  • Presents a positive image in and out of the office to fellow employees, members, providers, and the community.
  • Assist walk-in customers.
  • Research and handle all call backs related to provider and member issues.
  • Being available for the department and other departments when called upon for assistance.
  • Ensures phone/ACD goals and requirements are being adhered to.
Qualifications Excellent oral and written communication skills. Basic data entry skills. Ability to work with minimal supervision. 2 years experience in health care customer service required. High school education, two years of college preferred. Understanding of COBRA law and COB guidelines.
Physical Qualifications Must be able to sit for extended periods of time.
Additional Responsibilities Other duties as assigned. The above statements are intended to describe the general nature and level of work being performed by people assigned to this job. They are not intended to be an exhaustive list of all responsibilities, duties, and tasks required of the individual as classified.


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