Customer Service Representative I

• JOB SUMMARY/PURPOSE

  • Responsible for ensuring a high level of customer service and accuracy for plan benefits and accompanying workflow. Evaluates communications from members and providers of Health Plan Operations and processes requests accordingly. Acts as primary contact for plan benefit questions for all lines of business for both internal and external customers. Responsible for oral and written communications to members and providers in response to questions and requests.

• DEPARTMENT DESCRIPTION

  • Samaritan Health Plans (SHP) operates a portfolio of health plan products under several different legal structures: InterCommunity Health Plans, Inc. (IHN) is designated as a regional Coordinated Care Organization (CCO) for Medicaid beneficiaries; Samaritan Health Plans, Inc. offers Medicare Advantage and Commercial Large Group plans. As part of an Integrated Delivery System, Samaritan Health Plans is strategically and operationally aligned with Samaritan Health Services’ mission of Building Healthier Communities Together.

• EXPERIENCE/EDUCATION/QUALIFICATIONS

  • High School Diploma or equivalent required.
  • Two (2) years professional customer service experience required.
  • Experience in a health plan setting preferred.
  • Experience with State and Federal rules and regulations (including Medicare and Medicaid) preferred.

• KNOWLEDGE/SKILLS/ABILITIES

  • Effective written and verbal communication skills to perform group presentations, tactfully discuss issues, and listen to and understand concepts, rules and procedures. Ability to work with all levels within the organization, facilitate communication, and effectively document related activities.
  • Ability to identify complex problems, review related information, employ creativity and alternative thinking to develop and evaluate options and implement solutions.

• PHYSICAL DEMANDS

  • Rarely
    (1 - 10% of the time)

    Occasionally
    (11 - 33% of the time)

    Frequently
    (34 - 66% of the time)

    Continually
    (67 – 100% of the time)

    CLIMB - STAIRS

    LIFT (Floor to Waist: 0"-36") 0 - 20 Lbs

    LIFT (Knee to chest: 24"-54") 0 – 20 Lbs

    LIFT (Waist to Eye: up to 54") 0 - 20 Lbs

    CARRY 1-handed, 0 - 20 pounds

    BEND FORWARD at waist

    KNEEL (on knees)

    STAND

    WALK – LEVEL SURFACE

    ROTATE TRUNK Standing

    REACH - Upward

    PUSH (0 - 20 pounds force)

    PULL (0 - 20 pounds force)

    SIT

    CARRY 2-handed, 0 - 20 pounds

    ROTATE TRUNK Sitting

    REACH - Forward

    MANUAL DEXTERITY Hands/wrists

    FINGER DEXTERITY

    PINCH Fingers

    GRASP Hand/Fist

Location: Samaritan Health Services · SHS Health Plan Ops - COO
Schedule: 1.0 (80 hrs/pp), Day