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Job Description


The Customer Service Representative answers inbound queries from calls, email, and online chat platforms and makes outbound communications to support Customer Service Department operations in a manner that maintains compliance with insurance regulatory requirements and achieves Call Center service-level objectives. 


To perform this job successfully, an individual must be able to satisfactorily perform each essential duty listed below.

  • Act as the primary point of contact and liaison for the company members and providers contacting the plan regarding general inquiries, concerns or requests for information.
  • Develop a general understanding of all member-facing materials, communications and interactions and be prepared to respond appropriately to follow-up calls.
  • Answer inbound calls and/or place outbound calls in a high call volume environment and work directly with members and providers to accurately and completely answer inquiries involving the company program services and benefits.
  • Follow established guidelines and resources to respond to member and provider inquiries and resolve concerns in an accurate, timely, professional, and culturally competent manner.
  • Intake, handle and coordinate member grievances, appeals and billing issues, escalating to the Grievance and Appeals department, when necessary.
  • Educate members and providers on eligibility, and medical and pharmacy benefits and how to access services in a manner that achieves excellent service standards and maintains high customer satisfaction.
  • Use listening skills and judgment to appropriately categorize and accurately document all contacts and follow-up actions regarding member and provider communications and activities in accordance with established guidelines.
  • Appropriately handle member and provider requests through alternative channels such as e-mail, voicemail, fax, online chat, google chat, messenger, etc. in accordance with established procedures.
  • Triage member and provider requests or inquiries for other departments.
  • Conduct member surveys as assigned in accordance with established guidelines.
  • Attend and actively participate in daily, weekly, and monthly departmental meetings, in-services, training and coaching sessions.
  • Identify member/provider issues and trends and report relevant information to management.
  • Perform other related duties as required or assigned.

Reports To: Supervisor, Customer Experience Manager

REQUIREMENTS – Required (R) Desired (D)

The requirements listed below are representative of the knowledge, skill, and/or ability required or desired.

  • Excellent English reading, writing and speaking skills.
  • Minimum one year of experience in Customer Service or Call Center role, preferably within a Health Care, Insurance services, or Human Services programs. (R)
  • Ability to meet Key Performance Indicators by participating in and achieving the standards of the Customer Service Call Center Quality Program. (R)
  • Bi-lingual skills. (D)
  • MBA (D)
  • Working knowledge of and the ability to efficiently operate all applicable computer software including computer applications, such as Outlook, Word and Excel. (R)
  • Ability to use a keyboard with moderate speed and a high level of accuracy. (R)
  • Excellent communication skills including the ability to express oneself clearly and concisely when providing service to the company Plan members and providers over the telephone, in person, or in writing. (R)
  • Ability to think and work effectively under pressure and accurately prioritize and complete tasks within established timeframes. (R)
  • Ability to assume responsibility and exercise good judgment when making decisions within the scope of the position. (R)
  • Ability to maintain confidentiality. (R)
  • Ability to comply with all the company policies and procedures. (R)
  • Ability to perform the job safely with respect to others, to property, and to individual safety. (R)


Generally, duties are primarily performed in an office environment while sitting or standing at a desk. Incumbents are subject to frequent contact with and interruptions by co-workers, supervisors, and plan members or providers in person, by telephone, and by work-related electronic communications. Right now remote work capabilities are permitted, advised and available. The hours of operations for positions are based on US Pacific Standard Time. Available slots are 7:00am-17:00pm PSD and 17:00pm-1:00am PSD.


We are looking for a personable, experienced, sharp, and passionate Sales/Support Executives who want to make a significant impact on customer satisfaction and engagement. They must have the ability to manage multiple responsibilities with high attention to detail and professionalism.

This is an in-house and full-time position with the following responsibilities: 

1) Customer Communication

  • Engage customer effectively to ensure customer satisfaction
  • Responsive to customer queries and sales opportunities by handling calls, emails, chats, etc.
  • Build and maintain customer relationships
  • Keep existing Sales & Client Services reporting up to date on an annual, monthly, weekly, and daily basis with an emphasis on both efficiency and accuracy

2) Internal Team Coordination

  • Take a significant part in supporting decision-making processes and proactively push for new insights based on analytical research.
  • High emphasis on operation flow optimization, conclusions, and recommendations. 
  • Coordinate with different functional teams to implement.

Job Details

Total Positions:
1 Post
Job Shift:
Third Shift (Night)
Job Type:
Job Location:
No Preference
Minimum Education:
Degree Title:
Career Level:
Experienced Professional
Minimum Experience:
Fresh (Minimum one year of experience in Customer Service or Call Center role, preferably within a Health Care, Insurance services or Human Services programs)
Apply Before:
Dec 01, 2021
Posting Date:
Sep 24, 2021
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