Customer Service Rep (Remote) 2/13 Start Date

Role Purpose:

Customer Service Representative (CSR) is responsible for providing an enhanced customer experience for Dean Health Plan members, providers, and group representatives. An excellent CSR will have general knowledge of the variety of Dean Health Plan products, benefits and provider networks in order to explain the effective use of benefit plans and benefits available to members and providers and determine DHP's liabilities and obligations in various medical circumstances. CSR is expected to utilize excellent communication and problem-solving skills in order to resolve complex inquiries from internal and external customers. CSR must be customer-focused and motivated to implement ideal quality concepts with all callers including those who may be emotionally escalated. CSR will have the ability to work in a fast-paced, dynamic and technologically-based environment while having the ability to learn and implement new processes quickly. CSR will provide dependable and accurate results on a routine basis with close supervision and/or technical assistance. CSR must ensure compliance with department and regulatory requirements.

Training: 6-8 weeks of paid remote training (8:00-4:30pm CST M-F)

Work Hours: Varying shifts

Essential Job Duties:

1. Educate and inform members about the benefits available under and the requirements of Dean Health's benefit plans and provide assistance by initiating and coordinating the exchange of information among members, providers, and other internal departments involved in the relevant processes over the telephone.
2. Instruct members how to receive maximum benefit reimbursement, including the advantages of utilizing their primary care physician and network providers.
3. Determine the various policy provisions, guidelines, providers, and provider requirements and procedures; medical review procedures; and the procedures of other Dean Health Plan departments that apply to the need or concern of the member.
4. Access and research various information databases to obtain knowledge to provide complete and accurate answers and make appropriate decisions about the caller's situation.
5. Provide complete and accurate information about Dean Health Plan's ongoing and changing plans and benefits in response to caller questions and concerns.
6. Accurately and completely document each phone call in accordance with the department's standards, monitor the types of inquires received, and report trends and concerns to the Management Team.
7. Stay abreast of related regulatory, compliance, and departmental updates to meet departmental metric requirements.

Qualifications

Required:

1. Successful completion of the DHP Customer Service Training program.
2. Two years of inbound call center or related customer service experience
3. High school diploma or equivalent.
4. Strong verbal and written communication skills.
5. Proficient in Microsoft Office applications, with the ability to easily toggle between systems and navigate through the Internet.
6. Ability to type 40-45 wpm.
7. Ability to handle multiple tasks simultaneously, meet time-sensitive deadlines, and organize workloads with general supervision.
8. High level attention to detail and customer service, with the ability to handle sensitive and confidential information.
9. Ability to work well in a team based environment.
10. General knowledge of insurance terminology, diagnostic and procedure codes.

Preferred:

1. Background in the health insurance industry, working in a clinic or billing office.

Medica + Dean Health Plan

At Medica, we are committed to earning the trust of those we serve through our unwavering commitment to high quality, affordable health care. As one of the family of health plans with Medica, Dean Health Plan has been helping southern Wisconsin residents make the most of their coverage. It maintains a position of leadership in insurance services through a physician-led integrated health system that improves the health status of its members and delivers a superior level of service and care. Medica and Dean Health Plan, both mission-driven health plans, have significant similarities in our histories, operations, cultures, and deep community commitment. Together, there is an even greater opportunity to support the health care needs of members and patients, and to further enhance provider relationships.

Equal Opportunity Employer/Protected Veterans/Individuals with Disabilities

The contractor will not discharge or in any other manner discriminate against employees or applicants because they have inquired about, discussed, or disclosed their own pay or the pay of another employee or applicant. However, employees who have access to the compensation information of other employees or applicants as a part of their essential job functions cannot disclose the pay of other employees or applicants to individuals who do not otherwise have access to compensation information, unless the disclosure is (a) in response to a formal complaint or charge, (b) in furtherance of an investigation, proceeding, hearing, or action, including an investigation conducted by the employer, or (c) consistent with the contractor's legal duty to furnish information. 41 CFR 60-1.35(c)