NEW JOB OPENING
CUSTOMER SERVICE REPRESENTATIVE, MEMBER SVC CALL CENTER
IN Denver, CO, USA!

Word Model:

•Fully remote but local to Denver CO.



Education requirements:

• High School Diploma or General Education Development (GED) required.



Requirements:

•No time off during training and/or first 90 days of assignment.

•Must be flexible to work weekends and a late shift.

•Internet must be hardwired (no Wi-Fi accepted).

•Must have strong internet speed and a quiet place for remote work.



Basic Qualifications:

•Minimum two (2) years of call center or customer service experience required (Healthcare preferred).

•Basic Qualifications: Minimum two (2) years of customer service experience or Client member-interacting experience required.

•Additional Requirements: Excellent written and verbal communication skills. Demonstrated analytical and problem-solving skills. Working knowledge of systems used within the MSCC.



Additional Job Details:

•Workers are expected to be in attendance daily during/after training.

•Training will be 3 months. No time off will be approved.



Job Description:

•No time off during training - first 90 days of assignment.

•Summary: The Customer Service Representative is responsible for increasing customer satisfaction and retention by providing members, customers, patients, and providers with accurate, consistent, timely, and meaningful information. They will provide support to members'' inquiries and issues as they utilize the Client plan and provider services, continuing to build rapport and collaborative relationships with current and prospective members in accordance with compliance guidelines.



Major Responsibilities / Essential Functions:

•Available to handle member inquiries regarding:

•Member Core: Facility Inquiry, Web Support, Promote Client, Order ID Card, Complaint, ID Card Inquiry, Service Review.

•Member Advance: Eligibility Inquiry, Benefit Inquiry, General, Complaint, Correspondence Inquiry, Add/Remove Dependent, Service Review, New Member Experience, Internal Regional Request, IVR Defaults.

•Medicare (For up to two (2) regions).

•Premium Billing Enterprise: Billing Inquiry, Make Payment, Complaint, EFT Inquiry, General, Reinstatement Request, Service Review.

•Client Billing, 1095 Tax Form, SLP (escalations to Tier 3).*

•Represents Health Plan by answering and documenting all incoming contacts to determine their nature and to respond to complex calls related to specialized product lines or queues.

•Responds professionally to inquiries from internal/external customers.

•Promotes, ensures, and provides customer service to internal/external customers by demonstrating skills consistent with the organization''s philosophy of providing extraordinary customer relations and quality service.

•Initiates contact with the appropriate Health Plan, medical group, and facility personnel to obtain information relevant to the concern or inquiry as needed.

•Evaluates data to determine and implement the appropriate course of action to resolve the complaint and/or coordinate service recovery.

•Documents conversations with members according to procedure.

•Follows established procedures to meet customer/member needs.

•Required to effectively interact with diverse work units and relevant organizational departments.

•Has substantial understanding of the assigned skills and applies knowledge and skills to complete a wide range of tasks.

•Ability to understand relevant policies, processes, and customers.

•Assists the department in meeting customer needs and reaching department expectations.

•Completes required training and understands how to use tools available to recall necessary information.

•Develops a full awareness of the way performance and actions affect members and Member Service Contact Center''s (MSCC) performance guarantees (call handling, first call resolution, complaint resolution compliance, member retention, and return contact as warranted).

•Consistently supports compliance and the Principles of Responsibility (Client Code of Conduct) by maintaining the privacy and confidentiality of information and protecting the assets of the organization.

•Performs other relevant duties as required.



Shifts During Training, Nesting, and Production Operation Hours:

•Denver 04/14/2025 (CA Region):

•Training: 8:00 AM - 4:30 PM MT

•Nesting: 9:30 AM – 6:00 PM MT



Production Operation Hours (ALL LOCATIONS):

•The Member Service Contact Center (MSCC) operates Monday – Friday 7:00 AM – 9:00 PM and Saturday – Sunday 8:00 AM – 7:00 PM (Pacific Time).

• **Only those lawfully authorized to work in the designated country associated with the position will be considered.**

• **Please note that all Position start dates and duration are estimates and may be reduced or lengthened based upon a client’s business needs and requirements.**