Customer Services Specialist

* Job Title: Customer Services Specialist * * Job Location: * Milford, MI * Job Duration: * 3 Months (Possibility of extension) * Shift Time: 8:30 am to 6:00 pm Monday to Friday * * * * Job Summary: * · This position has the following primary objectives with respect to customer relations for all HAP product lines: · Provide follow-up and courteous and prompt resolution to member inquiries by conducting thorough investigations and fully educating members and customers. · Support corporate and departmental goals, member enrolment activities and product implementations. · Research, investigate and resolve service failures. Improve the customer experience by identifying root causes, trends and recommend resolutions for service recovery and retention. · Educate members and prospective members to promote HAP as the health care coverage of choice. * * * Duties and Responsibilities: * · Respond to inquiries by telephone, mail and in person; research and answer inquiries, complaints and appeals by following all department standards, policies and procedures; direct inquiries to supporting departments for appropriate action and resolution. · Educate existing and potential members on policies, procedures, product offerings, benefit plan and coverage provisions related to all HAP products. · Document all incoming inquiries accurately in to track member inquiry history and trends. · Practice and maintain confidentiality to Privacy and HIPAA regulations. · Proactively seek training and development to enhance skills and abilities. · Monitor workflow inbox and outstanding cases to ensure that all inquiries receive an appropriate response in a timely manner; contact members (by phone/or in writing), as needed, to ensure timely resolution and follow-up to inquiry. · Interact with support departments in a professional manner to ensure member needs are met. · Develop and maintain strong business relationships with inter-departments; continue to self-educate on changes in policies and procedures that occur in other departments which could have an impact on department operations and the servicing of member/customers. · Attend training and development sessions or continuing education opportunities offered by Customer Service and maintain enhanced skill levels and performance. · Interact with providers and their staff to obtain information for resolving customer inquiries and complaints. · Ensure and maintain compliance of all department and corporate standards, policies and procedures. · Recommend process improvements based on observations and trends identified while interacting with internal and external customers. · Coordinate and assist with various departmental projects, member enrolment periods, outreach activities and corporate initiatives. · Perform other related duties as assigned. *Education:* · Course in Medical Terminology (required completion within six months post-employment). · Associate’s degree OR · A minimum of four (4) years of recent and related work experience in a customer service capacity may be considered in lieu of the degree. *Skills:* · Minimum of two (2) years of recent Customer Service or Call Centre experience within the last three years. · Must be dependable. · Demonstrate a high degree of integrity, patience, maturity, empathy, tact and Diplomacy. · Demonstrate problem solving skills, flexibility, good judgment and ability to provide service excellence. · Demonstrate the ability to handle assigned projects from start to successful completion including appropriate follow-up and documentation. · Demonstrate the ability to handle multiple priorities concurrently in a timely and accurate manner. · Demonstrate strong interpersonal, listening, verbal communication and business writing skills. · Demonstrate efficiency in using a PC and various Microsoft programs. · *Fundamental understanding of HMO/PPO/POS delivery system and claims billing.* · Must be able to work flexible shifts, overtime including evenings and weekends as requested and/or scheduled.

Location: Milford, CT, US

Posted Date: 5/25/2025