Customer Service Representative II

How You Will Contribute

Customer Support & Advocacy

• Maintains a positive and approachable demeanor in all customer interactions, showing a genuine interest in helping consumers and improving their experience.
• Helps member employees navigate their health insurance network providers.
• Independently provides customer service via telephone and email, answering questions and resolving issues related to electronic claims filing, repricing, network-related inquiries, and other established Customer Services processes.
• Refers consumers to the appropriate third-party administrator (TPA) or other resource for claims status, eligibility, or matters requiring assistance outside The Alliance’s scope.
• Provides education and resources to empower consumers to make informed health care decisions.
• Responds to written correspondence within established timeframes.

Issue Resolution & Collaboration

• Researches customer questions and concerns using available systems and resources and identifies appropriate solutions or next steps.
• Independently resolves standard customer issues and determines when additional expertise, referral, or escalation is appropriate.
• Takes ownership of customer inquiries and supports timely follow-through and resolution.
• Accurately documents customer interactions, research, actions taken, and relevant information to support continuity of service.
• Collaborates with Customer Services staff, other departments, and appropriate external partners to resolve customer issues.

Customer Insights & Continuous Improvement

• Proactively collects and shares consumer feedback to identify recurring concerns and opportunities to improve the customer experience.
• Recognizes patterns in customer inquiries and communicates observations to the Director or other appropriate Alliance staff.
• Contributes ideas and feedback that support improvements to Customer Services processes, resources, and service delivery.
• Maintains proficient knowledge of The Alliance’s networks, services, systems, terminology, and Customer Services processes.
• Assists with data entry and other departmental responsibilities as needed.