Customer Service Rep 11-378

Customer Service Rep 11-378

Customer Service Rep 11-378


Job Title: Customer Service Rep 11-378
Job Type: Full-Time
Location: Toledo, OH
Post Date: 12/22/2011








Job Description:

Job Summary:

Medical Mutual is seeking excellent Customer Service Representatives to join our call center team. Successful candidates will render a variety of services to our health care customers up to and including answering incoming phone calls, responding to correspondence, assisting walk-in customers, analyzing and researching information and processing claims and adjustments. Excellent candidates will have the ability to apply their knowledge in order to work independently, obtain first call resolution and contribute to our corporate goals. Perfect candidates will pride themselves on their ability to enhance the customer service experience by providing exceptional customer service and projecting a professional image. Candidates will be expected to learn a great deal of information in order to ensure the accuracy of services provided. Some of this information may include, understanding various claims processing systems, benefits, contract expectations, corporate and departmental procedures/policies, applicable insurance regulations, etc.

Primary Responsibilities:

1. Performs all administrative customer satisfaction services including claims adjudication, phone, written and/or walk in correspondence and adjustments.
2. Primary responsibility is to provide phone customer service. Analyzes, researches and completes on line or manual adjustments of paid or rejected claims to: process claims of all types from receipt to completion, respond to telephone inquiries, review and/or initiate correspondence and adjustments, and receive walk in clients regarding the status of health care claims.
3. Maintains thorough knowledge of various automated claims processing systems, lines of business, procedures, benefits and rates, contracts, enrollment, billing, underwriting, specific group/provisions, applicable insurance regulations and related corporate policies to ensure the accuracy of services provided. Utilizes in-depth claims adjudication knowledge and techniques to independently (a) provide a sound level of service and (b) contribute to corporate sales efforts to retain existing and attain new accounts.

Qualifications:

. Demonstrated proficiency in a job related field of concentration with specialized skill exercising logic to distinguish fact from opinion, define and analyze problems, draw conclusions, evaluate solutions and communicate complex concepts as typically acquired through a Bachelor's Degree in Business Administration or two (2) years customer service experience, which could be evidenced through the professional environments of Health Care, Banking, Retail, etc.
. Demonstrated strong interpersonal and communication skills (verbal and written) to effectively and confidentially articulate policies, procedures and claim interpretation.
. Ability to successfully complete claims/customer service training programs. (NOTE: Will be subject to formalized skill assessment proceedings. Must receive an 85% or better cumulative score from training class tests).
. Familiarity with PCs including demonstrated navigational skills in a Windows environment and proficient keyboarding skills (minimum 4000 kpi score).
. Above average analytical, problem-solving, and organizational and decision making skills.
. Receptive to fast-paced environment, production criteria, changing priorities, training and overtime assignments.
. Must maintain minimum levels of established unit goals.

. Please note, this position is for our Toledo facility. The hours for this position are 10:00a-6:30p or 11:00a to 7:30p M-F and 9:00a - 1:00p Sat. Training hours are 8:00a-4:30p M-F. Please visit our website to apply for the Customer Service Representative 2011-378.

We are proud to be an EEO/AA employer M/F/D/V. We maintain a drug-free workplace and perform pre-employment substance abuse and tobacco testing.