Terms of Employment
- W2 Contract, 4 Months
- Onsite in Tallahassee, FL
- Work Schedule:
- M-F 7:00 AM to 6:00 PM MT on all State business days(excluding Wyoming State holidays).
- This Call Center Representative is a front-line service position aiding Wyoming Benefits Management System and Services (WY BMS) members and providers regarding programs, policies, and procedures.
- Responsibilities include:
- Answering incoming calls related to eligibility, benefits, claims and authorization of services from members or providers.
- Administration of intake documentation into the appropriate systems.
- Overall expectations are to provide outstanding service to internal and external customers and strive to resolve member and provider needs on the first call.
- Performance expectations are to meet or exceed operations production and quality standards.
- Training Schedule
- 8 AM to 5 PM EST subject to changes if necessary.
- Post Training Schedules
- May vary upon call volumes and other factors.
- Responsible for meeting call handling requirements and daily telephone standards as set forth by management; accurately respond to inbound phone calls and processing provider and member inquiries and requests into the appropriate system and database.
- Under general supervision, resolve customers’ service or billing complaints by demonstrating sound judgement; contact customers to respond to complex inquiries or to notify them of claim investigation results and any planned adjustments.
- Under general supervision, resolve customer administrative concerns as the first line of contact this may include
- Claim resolutions and other expressions of dissatisfaction; refer unresolved customer grievances, appeals, and claim resolution to designated departments for further investigation.
- Actively listen and probe callers in a professional and timely manner to determine purpose of the calls, keep records of customer interactions and transactions, recording details of inquiries, complaints, and comments, as well as actions taken.
- Under general supervision, research and articulately communicate information regarding member eligibility, benefits, services, claim status, and authorization inquiries to callers while maintaining confidentiality.
- Assist efforts to continuously improve by assuming responsibility for identifying and bringing to the attention of responsible entities operations problems and/or inefficiencies.
- Assume full responsibility for self-development and career progression; proactively seek and participate in ongoing training sessions (formal and informal).
- Educate providers on how to submit claims and when/where to submit a treatment plan.
- Under general supervision, perform necessary follow-up tasks to ensure member or provider needs are completely met.
- Support team members and participate in team activities to help build a high-performance team.
- Thoroughly document customers’ comments/information and forward required information to the appropriate staff.
- Escalate calls to Call Center Lead when necessary
Required Skills & Experience
- High school graduate or have equivalent experience.
- Must have Healthcare experience
- Good verbal and written communication skills, attention to detail, customer service skills and interpersonal skills.
- Work independently and manage your time and can accurately document and record customer/client information.
- Customer service-related experience.
- Previous experience with computer applications, such as Microsoft Word and PowerPoint.
- Must be a proficient typist (avg. 35+ WPM) with strong written and verbal communication skills.
- Must be able to maneuver through various computer platforms while verifying information on all calls.
- Must be able to talk and type simultaneously.
- Must be flexible in scheduling and comfortable with change as customer service is an ever-changing environment.
- Must be able to manage difficult calls with angry customers without getting rattled.
- Must be proficient in windows computer systems and able to navigate multiple monitors and systems simulatenously
Preferred Skills & Experience
- Bilingual Spanish speaking.
- Medicaid experience.