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Customer Services Representative

Location: Rancho Cordova
Posted on: July 8, 2024

Job Description:

The Customer Service Representative is responsible for receiving, answering, and/or resolving calls received through a Call Center. The Call Center receives phone calls from insured?s and their dependents, providers and their staff, employer/group staff, and brokers. The CSR will use the internal database to inquire on the status of claims ID cards, addresses, and other issues as queried by the caller. The CSR is also the primary source for issuing authorizations when eligible for services. In addition, the CSR will perform duties consistent with customer/provider service.

Duties and Accountabilities:

1.Provide timely and accurate information to basic incoming customer calls from members, providers, and other external and internal constituents including:

a.Issuing authorizations,

b.Handling claim inquiries from providers and members,

c.Communicate the correct information regarding accessibility, claims status and other calls of a service nature, and

d.Providing benefits information.

2.Process customer claims according to established department policies and procedures.

3.Checking voicemail boxes and handling customer/provider requests for:

-I.D. cards


-Customer Service questions and issues.

4.Fulfill rapid call volume by handling the appropriate amount of calls coming into the call center daily.

5.Complete Provider Relations requests for service.

6.Provide timely feedback to the company regarding customer service failures and/or customer/provider concerns.

7.Partner with Sales and Provider Relations to meet and exceed customer?s service expectations.

8.Provide excellent customer service and handle all customers in a professional and courteous manner.

9.Perform other related duties as assigned.


-Excellent interpersonal verbal and written communication skills.

-Communication skills including the ability to diffuse volatile situations, share information, and educate callers regardless of level of understanding.

-Understanding of managed care or insurance industries.

-Strong execution and follow-up skills.

-Goal oriented with ability to meet production standards.

-Team orientation and ability to work effectively across functional areas of the company.

-Well Organized and Resourceful.

-Accurate and efficient data entry skills.

-Ability to work independently with moderate supervision.

-Ability to coordinate multiple tasks and projects.

-Excellent customer service skills (friendly, courteous and helpful).

-Skilled in dealing with all customers in an efficient and effective manner.

-Bilingual skills helpful. We are an equal employment opportunity employer and will consider all qualified candidates without regard to disability or protected veteran status.

Keywords: , Rancho Cordova , Customer Services Representative, Healthcare , Rancho Cordova, California

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