Customer Service Representative

Summary
The Customer Service Representative is a front line representation of the company's Core Values. They have the important task and critical role of setting the tone for how callers review our professionalism, plan knowledge and ability to deliver world class customer service.
The Customer Service Representative is responsible for answering inbound calls in a timely manner within a call center environment. They are required to complete research using provided resources to ensure accurate and quality service is being delivered as contracted with the client while remaining within CMS guidelines and adhering to department internal policies and procedures. Outbound calls are periodically conducted for surveys and resolution of outstanding issues.

Duties and Responsibilities:
* Answer inbound calls from members, member representatives, agent brokers, providers, health plan employees, ship employees and clients.
* Perform outbound calls to resolve pended issues and COB surveys.
* Research caller's inquiries using internal knowledge database, client website, routes and escalation process to resolve concerns.
* Clear and concise documentation of each task is required in TMGCALL.
* Timely resolution of self pended calls.
* Alert supervisor and management to any known telephone, systems, policies and procedures or other obstacles interfering with customer satisfaction and delivery of timely service.
* Performs as an advocate by educating the caller of all necessary information and alternatives as it relates to the call to promote one call resolution.
* Develop and maintain effective working relationships with internal and external customers.
* Adhere to department and corporate guidelines. Follow internal policy and procedures.
* De-escalate situations in a professional, calm and customer focused manner.
* Utilize department best practices to increase productivity, once call resolution and patient satisfaction.
* Other duties as assigned.