PHP-CUSTOMER SERV SPECIALIST I

We are Looking for great Customer Service Representatives to work with our team in enhancing the Member Experience. This Full Time role is mostly remote once training has been completed. Apply to join our team today.

Positions Location: Lansing, MI

Job Description

General Purpose of Job:  

Responsible for supporting Customer Service goals and objectives by interacting directly with members, providers, group administrators, Cognizant (and other business partners) and PHP staff to relay information and resolve inquiries and issues.

Essential Duties:

This job description is intended to cover the minimum essential duties assigned on a regular basis.  Caregivers may be asked to perform additional duties as assigned by their leader. Leadership has the right to alter or modify the duties of the position.

• Respond to incoming telephone or written inquiries from members, providers, employers, vendors and PHP staff regarding eligibility, benefits, claim status/issues, pharmacy, policies and procedures, contract terms, referrals etc.
• Make outbound telephone calls to resolve inquiries and issues.
• Complete understanding of all products and benefit lines.
• Research issues relating to eligibility, benefits, claim status/issues, pharmacy, policies and procedures, contract terms, referrals, etc.
• Following department/company guidelines, makes independent decisions to resolve caller's issues.
• Act as a member advocate in the member appeal/grievance process.
• Provide direction to members, providers, employers.
• Serves as a role model for consistent demonstration of Sparrow Health System's Customer Service Behavioral Standards of Performance, by respecting the Privacy and Confidentiality of those we serve.
• Demonstrates knowledge and respects patient, service provider, organizational confidentiality and HIPAA Security procedures and protocols as defined under the HIPAA Privacy and Security Procedures
• Provide support for customers requiring assistance in person.

• Other duties as assigned

   

   

   

Job Requirements

General Requirements

Required Responsibilities of the Caregiver: • Demonstrates knowledge and maintains and respects patient right to privacy by following the HIPAA Privacy and Security policies and procedures. • Adheres to ICARE values and standards of behavior (Innovation, Compassion, Accountability, Respect, Excellence). • Role model behaviors that value the diversity of our caregivers, patients and customers and supports creating an environment that is inclusive, welcoming and respectful. • Communicates with patients, families and customers using AIDET (Acknowledge, Introduce, Duration, Explanation, Thank). • Works in a safe manner and promptly reports any hazards identified in the work environment or related to assigned responsibilities. • Adheres to policies and procedures designed to avoid, prevent and reduce the spread of communicable diseases.