Assists Customer Service Team Leader in resolving customer concerns, providing appropriate education/instruction and maintaining customer satisfaction by providing the highest level of customer service in only one of the Primary Functions (enrollment, claims or phones).
Proficient in one or more of the three GHP lines of business including the following product designs:
HMO which includes: HMO, HMO Point of Service, HMO Extra, HMO Point of Service Extra, Solutions HMO, Solutions Point of Service, Solutions Extra, Solutions Point of Service Extra, GHP Direct, GHP Solutions Direct, GHP Direct Point of Service, GHP Solutions Direct with Point of Service, Choice PPO with Referral, Marketplace Solutions, Marketplace Solutions Extra, Marketplace Solutions QHDHP, Marketplace Value, Marketplace HMO, Marketplace HMO POS, Marketplace HMO HDHP and Marketplace HMO Extra.
TPA which includes: High Deductible Health Plan, Choice PPO no referral, Direct Access, Indemnity, Marketplace Direct, Marketplace Direct QHDHP and all self-funded third party administrators including GHS.
Actively participates in cross training, improving processes within the Customer Service team. Responsible for attaining and maintaining "key performance measures" established for the Customer Service Team in the primary functions of claims, enrollment and phones.
Works under the direction of the Customer Service Team Leader.
Cross training is based on experience and departmental need.
COMPETENCIES AND SKILLS:
Demonstrates excellent communication, problem solving, and customer-service skills within a team atmosphere.
Demonstrates excellent organization and time management skills and ability to work independently.
Demonstrates ability to work with and manage multiple data sets. Demonstrates good verbal and written skills and ability to work with all levels of Health Plan personnel.
Demonstrates competence in written, oral and electronic communication skills (interpersonal/communication and technological effectiveness competencies).
Demonstrates the ability to be flexible to change.
Demonstrates the ability to be a team player.
Strong keyboarding skills.
Demonstrates competence in maintaining department standards in a fast paced office environment.
Demonstrates ability to be detail oriented.
Demonstrates ability to multitask and function under pressure to ensure Health Plans goals are met.
Demonstrates customer service skills.
Demonstrates strong problem solving skills.
Demonstrates ability to participate in problem solving situations.
Demonstrates strong organizational and analytical skills.
Demonstrates the ability to maintain confidentiality
The specific statements shown above are not intended to be all-inclusive. They represent typical elements considered necessary to successfully perform the job
EDUCATION AND/OR EXPERIENCE:
High School diploma and minimum one year customer service, hospital or insurance experience, including patient or public contact, required.
If primary function is in claims, basic knowledge of the CPT-4, HCPCS and ICD-9-CM coding manuals preferred
WORKING CONDITIONS/PHYSICAL DEMANDS:
Work is typically performed in an office environment
OUR PURPOSE & VALUES: Everything we do is about caring for our patients, our members, our students, our Geisinger family and our communities. KINDNESS: We strive to treat everyone as we would hope to be treated ourselves. EXCELLENCE: We treasure colleagues who humbly strive for excellence. LEARNING: We share our knowledge with the best and brightest to better prepare the caregivers for tomorrow. INNOVATION: We constantly seek new and better ways to care for our patients, our members, our community, and the nation.
GEISINGER HEALTH PLAN (GHP) is the health insurance component of Geisinger and serves over 460,000 members in Pennsylvania and West Virginia. Begun in 1985, GHP provides high quality, affordable health-care benefits for businesses of all sizes, individuals and families, and Medicare beneficiaries.
About Geisinger: Geisinger is a physician-led health system comprised of approximately 30,000 employees, including nearly 1,600 employed physicians, 13 hospital campuses, two research centers, and a 583,000-member health plan Geisinger is nationally recognized for innovative practices and quality care. Geisinger serves more than 3 million people in central, south-central and northeast Pennsylvania and also in southern New Jersey with the addition of National Malcolm Baldridge Award recipient AtlantiCare, A member of Geisinger. In 2017, the Geisinger Commonwealth School of Medicine became the newest member of the Geisinger Family.
Internal Number: 62941
At Geisinger, our innovative ideas are inspired by the communities we serve – like our Fresh Food
Farmacy, a program that delivers life-saving healthy alternatives to patients with diabetes. With additional tools like our MyCode Community Health Initiative, one of the first health system genome sequencing
programs, and our new asthma app suite that we developed in partnership with AstraZeneca, it’s no wonder we’re ranked one of the Top 5 Most Innovative Healthcare Systems by Becker's Hospital Review. We continually work towards continuous improvement in a culture where everyone has a voice and firmly believe that better begins with all of us.
Founded more than 100 years ago, Geisinger serves more than three million residents throughout central, south-central and northeastern Pennsylvania and southern New Jersey. Our physician-led system is comprised of 30,000 employees, including 1,600 employed physicians, and consists of 13 hospital campuses, the Geisinger Health Plan, Geisinger Commonwealth School of Medicine and two research centers.
What you do at Geisinger shapes the future of health and improves lives – for our patients, communities, and you.