Customer Care Representative I

Your Talent. Our Vision. At Simply Healthcare, a proud member of the Anthem, Inc. family of companies, it’s a powerful combination and the foundation upon which we’re creating greater care for our members, greater value for our customers, and greater health for our communities. We are a Florida licensed health maintenance organization that serves individuals enrolled in Medicaid and/or Medicare programs, Join us and together we will drive the future of health care. This is an exceptional opportunity to do innovative work that means more to you and those we serve.

Customer Care Representative I-III

Your compassion. Our customer focus. It’s a powerful combination that will help Anthem, Inc. drive the future of health care.

Our Customer Care Representative position is an opportunity to put your communication, problem solving, and superior service skills to work while providing valuable information and resources to the people we serve. This role will enable you to set a career path in the healthcare industry and play a vital role in helping Anthem consumers feel important, cared-for and well-informed.
We are seeking talented and enthusiastic individuals to engage with our customers and serve as a primary resource in guiding them through the sometimes complex world of healthcare. A background in the healthcare industry is not required, but you must be a self-motivator and share our commitment to an easy to do business with model. We are looking for people who have a passion for helping others through the following qualities:

• Heart of service or hospitality
• Passionate about helping people resolve problems
• Empathetic
• Curious about others
• Sincere satisfaction in providing a high level of service
• Desire to solve problems and dig deeper
• Ability to connect the dots for members
• Interest in solving healthcare challenges for consumers

* Manager will determine level based upon the selected applicant’s skillset relative to the qualifications listed for this position.*

Description

Level I:

• Successfully completed the required basic training, able to perform basic job functions with help from co-workers, specialists and managers on non-basic issues.
• Must pass the appropriate pre-employment test battery.

Primary duties may include, but are not limited to:

• Responds to customer questions via telephone and written correspondence regarding insurance benefits, provider contracts, eligibility and claims.
• Analyzes problems and provides information/solutions.
• Operates a PC/image station to obtain and extract information; documents information, activities and changes in the database.
• Thoroughly documents inquiry outcomes for accurate tracking and analysis.
• Develops and maintains positive customer relations and coordinates with various functions within the company to ensure customer requests and questions are handled appropriately and in a timely manner.
• Researches and analyzes data to address operational challenges and customer service issues.
• Provides external and internal customers with requested information.
• Under immediate supervision, receives and places follow-up telephone calls / e-mails to answer customer questions that are routine in nature.
• Uses computerized systems for tracking, information gathering and troubleshooting.
• Requires limited knowledge of company services, products, insurance benefits, provider contracts and claims.
• Seeks, understands and responds to the needs and expectations of internal and external customers.
• Required to meet department goals and expectations.
• Solving challenging problems for members that impact their healthcare needs.
• Providing vital information to members’ healthcare needs.
• Being a consumer advocate to assist members with specific needs.

Level II:

• Responds to customer questions via telephone and written correspondence regarding insurance benefits, provider contracts, eligibility and claims.
• Proficient in all basic customer service areas performs some but not all types of moderately complex function.
• Must be able to successfully perform all the duties of the Customer Care Rep I.

Primary duties may include, but are not limited to:

• Proficient in all basic customer service functions.
• Receives and places follow-up telephone calls / e-mails to answer customer questions. Inquiries may also be on a walk-in basis.
• May require deviation from standard practices and procedures with the assistance of a computerized system.
• Requires general knowledge of company services, products, insurance benefits, provider contracts and claims.

Level III:

• Reviews requests by mail, telephone, or in person regarding insurance claims/policies.
• Fully proficient in all key areas; performs many complex functions.
• Must be able to successfully perform all the duties of the Customer Care Rep II.

Primary duties may include, but are not limited to:

• Responds to inquiries from policyholders, providers and/or others for information and assistance.
• Performs research to respond to inquiries and interprets policy provisions to determine most effective response.
• Required to meet department goals and expectations.

Qualifications

Level I:

• Requires a High School diploma/GED;
• up to 1 year of previous experience in an automated customer service environment;
• or any combination of education and experience, which would provide an equivalent background.
• Must be willing to work a flexible schedule, as overtime/weekends may be required at certain times in the year.
• The hours of operation are from 8:00AM-8:00PM EST.
• Bilingual (Spanish) preferred.
• Previous Medicare and/or Medicaid experience preferred.

Level II:

• Requires a High School diploma/GED;
• 1 to 3 years of Anthem experience in an automated customer service environment;
• or any combination of education and experience, which would provide an equivalent background.
• Must be willing to work a flexible schedule, as overtime/weekends may be required at certain times in the year.
• The hours of operation are from 8:00AM-8:00PM EST.
• Bilingual (Spanish) preferred.
• Previous Medicare and/or Medicaid experience preferred.

Level III:

• Requires a High School diploma/GED;
• 3 to 5 years of Anthem experience in an automated customer service environment;
• or any combination of education and experience, which would provide an equivalent background.
• Must be willing to work a flexible schedule, as overtime/weekends may be required at certain times in the year.
• The hours of operation are from 8:00AM-8:00PM EST.
• Bilingual (Spanish) preferred.
• Previous Medicare and/or Medicaid experience preferred.

Anthem, Inc. is ranked as one of America’s Most Admired Companies among health insurers by Fortune magazine, and is a 2016 DiversityInc magazine Top 50 Company for Diversity. To learn more about our company please visit us at antheminc.com/careers. EOE. M/F/Disability/Veteran.