Individual Service Representative
Company Name:
PacificSource Health Plans
Provide professional, high quality customer service to individual applicants, members, producers, and internal customers. Must answer high volume of incoming calls in concert with time sensitive document processing.
1. Answer high volume of incoming calls and document in call tracking database. Generate member and producer phone calls and e-mail messages for pending application resolutions.
2. Generate new policies and all pertinent new issue documents using Word, Excel, and PSE.
3. Assist outside agents with inquiries, providing prompt, courteous, and accurate service and information. Interpret and determine applicable laws, policies, and codes to ensure legal compliance and accurate information. Research and resolve agent and member problems and provide follow-up within one business day.
4. Review applications and request missing information from members and producers.
5. Document all underwriting resolutions within EET stat screen. Provide e-mail to agent or member regarding decisions. Process member letter explaining denial or generate policy for approved applicants.
6. Collect all missing information for underwriting process.
7. Generate letters, memos, and custom documents following company style guidelines to ensure consistency and grammar and spelling accuracy.
8. Handle all Individual Department change requests, including data entry and final processing.
9. Document calls in the Call Tracking system.
10. Coordinate and distribute denial letters.
11. Provide initial notice to agents regarding auto approvals and auto denials.
12. Monitor and respond to messages in the Individual Department e-mail and voicemail queues.
13. Assist with walk-in traffic and answering sales phone queue.
14. Enter applications into the Facets system.
Supporting
Responsibilities:
1. Meet department and company performance and attendance expectations.
2. Consistently demonstrate commitment and support in meetings and training sessions.
3. Follow the PacificSource privacy policy and HIPAA laws and regulations concerning confidentiality and security of protected health information.
4. Perform other duties as assigned.
Work
Experience: A minimum of one year of administrative work experience in the health insurance industry.
Education, Certificates, Licenses: High school diploma or equivalent required.
Knowledge: Must possess excellent communication skills, both written and verbal. Ability to effectively articulate benefits, rates, underwriting risks, and processes to internal and external customers. Exceptional grammar, spelling, punctuation, consistency, proofreading, and editing skills. Requires basic math skills and spreadsheet skills. Requires the ability to define and prioritize problems and workload without specific direction.
Competencies
Our Values
Building Customer Loyalty
Building Strategic Work Relationships
Continuous Improvement
Adaptability
Building Trust
Work Standards
Contributing to Team Success
Planning and Organizing
We are committed to doing the right thing.
We are one team working toward a common goal.
We are each responsible for our customer's experience.
We practice open communication at all levels of the company to foster individual, team and company growth.
We actively participate in efforts to improve our many communities-internally and externally.
We encourage creativity, innovation, continous improvement and the pursuit of excellence.
Environment: Work inside in a general office setting with ergonomically configured equipment. Travel is required approximately less than 5% of the time.
Physical Requirements: Stoop and bend. Sit and/or stand for extended periods of time while performing core job functions. Repetitive motions to include typing, sorting and filing. Light lifting and carrying of files and business materials. Ability to read and comprehend both written and spoken English. Communicate clearly and effectively.
Disclaimer: This job description indicates the general nature and level of work performed by employees within this position and is subject to change. It is not designed to contain or be interpreted as a comprehensive list of all duties, responsibilities, and qualifications required of employees assigned to this position. Employment remains AT-WILL at all times.
PacificSource Health Plans is an equal opportunity employer. All qualified applicants will receive consideration for employment without regard to status as a protected veteran or a qualified individual with a disability, or other protected status, such as race, religion, color, national origin, sex, age.
Date: 2014-07-17
Country: US
State: ID
City: Boise
Postal Code: 83706
Job Type: Regular Full-TimeEstimated Salary: $20 to $28 per hour based on qualifications.
PacificSource Health Plans
Provide professional, high quality customer service to individual applicants, members, producers, and internal customers. Must answer high volume of incoming calls in concert with time sensitive document processing.
1. Answer high volume of incoming calls and document in call tracking database. Generate member and producer phone calls and e-mail messages for pending application resolutions.
2. Generate new policies and all pertinent new issue documents using Word, Excel, and PSE.
3. Assist outside agents with inquiries, providing prompt, courteous, and accurate service and information. Interpret and determine applicable laws, policies, and codes to ensure legal compliance and accurate information. Research and resolve agent and member problems and provide follow-up within one business day.
4. Review applications and request missing information from members and producers.
5. Document all underwriting resolutions within EET stat screen. Provide e-mail to agent or member regarding decisions. Process member letter explaining denial or generate policy for approved applicants.
6. Collect all missing information for underwriting process.
7. Generate letters, memos, and custom documents following company style guidelines to ensure consistency and grammar and spelling accuracy.
8. Handle all Individual Department change requests, including data entry and final processing.
9. Document calls in the Call Tracking system.
10. Coordinate and distribute denial letters.
11. Provide initial notice to agents regarding auto approvals and auto denials.
12. Monitor and respond to messages in the Individual Department e-mail and voicemail queues.
13. Assist with walk-in traffic and answering sales phone queue.
14. Enter applications into the Facets system.
Supporting
Responsibilities:
1. Meet department and company performance and attendance expectations.
2. Consistently demonstrate commitment and support in meetings and training sessions.
3. Follow the PacificSource privacy policy and HIPAA laws and regulations concerning confidentiality and security of protected health information.
4. Perform other duties as assigned.
Work
Experience: A minimum of one year of administrative work experience in the health insurance industry.
Education, Certificates, Licenses: High school diploma or equivalent required.
Knowledge: Must possess excellent communication skills, both written and verbal. Ability to effectively articulate benefits, rates, underwriting risks, and processes to internal and external customers. Exceptional grammar, spelling, punctuation, consistency, proofreading, and editing skills. Requires basic math skills and spreadsheet skills. Requires the ability to define and prioritize problems and workload without specific direction.
Competencies
Our Values
Building Customer Loyalty
Building Strategic Work Relationships
Continuous Improvement
Adaptability
Building Trust
Work Standards
Contributing to Team Success
Planning and Organizing
We are committed to doing the right thing.
We are one team working toward a common goal.
We are each responsible for our customer's experience.
We practice open communication at all levels of the company to foster individual, team and company growth.
We actively participate in efforts to improve our many communities-internally and externally.
We encourage creativity, innovation, continous improvement and the pursuit of excellence.
Environment: Work inside in a general office setting with ergonomically configured equipment. Travel is required approximately less than 5% of the time.
Physical Requirements: Stoop and bend. Sit and/or stand for extended periods of time while performing core job functions. Repetitive motions to include typing, sorting and filing. Light lifting and carrying of files and business materials. Ability to read and comprehend both written and spoken English. Communicate clearly and effectively.
Disclaimer: This job description indicates the general nature and level of work performed by employees within this position and is subject to change. It is not designed to contain or be interpreted as a comprehensive list of all duties, responsibilities, and qualifications required of employees assigned to this position. Employment remains AT-WILL at all times.
PacificSource Health Plans is an equal opportunity employer. All qualified applicants will receive consideration for employment without regard to status as a protected veteran or a qualified individual with a disability, or other protected status, such as race, religion, color, national origin, sex, age.
Date: 2014-07-17
Country: US
State: ID
City: Boise
Postal Code: 83706
Job Type: Regular Full-TimeEstimated Salary: $20 to $28 per hour based on qualifications.
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