NEW JOB OPENING CUSTOMER SERVICE REPRESENTATIVE IN Remote, USA!

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Job Description Required Education:• High School or GED equivalent.Preferred Experience:• Healthcare insurance and call center experience is preferred.Required Qualifications/Skills/Experience:• Customer Service experiences in a transaction-based environment, such as a call center or retail location, demonstrating ability to be empathetic and compassionate.• Experience in a production environment.Duties:• Answers questions and resolves issues based on phone calls/letters from members, providers, and plan sponsors. Triages result in rework for the appropriate staff.• Documents and tracks contacts with members, providers, and plan sponsors. The CSR guides the member through their member's plan of benefits, Client policy and procedures as well as having knowledge of resources to comply with any regulatory guidelines.• Creates an emotional connection with our members by understanding and engaging the member to the fullest to champion for our members'' best health.• Taking accountability to fully understand the member's needs by building a trusting and caring relationship with the member.• Anticipates customer needs. Provides the customer with related information to answer the unasked questions, e.g. additional plan details, benefit plan details, member self-service tools, etc.• Uses customer service threshold framework to make financial decisions to resolve member issues.• Explains members' rights and responsibilities by the contract.• Processes claim referrals, new claim handoffs, nurse reviews, complaints (member/provider), grievance and appeals (member/provider) via the target system.• Educates providers on our self-service options; Assists providers with credentialing and recredentialing issues.• Responds to requests received from the Client's Law Document Center regarding litigation and lawsuits.• Handles extensive file review requests.• Assists in the preparation of complaint trend reports. Assists in compiling claim data for customer audits.• Determines medical necessity, applicable coverage provisions, and verifies member plan eligibility for incoming correspondence and internal referrals.• Handles incoming requests for appeals and pre-authorizations not handled by Clinical Claim Management.• Reviews member claim history to ensure accurate tracking of benefit maximums and/or coinsurance/deductible. Performs financial data maintenance as necessary.Industry: Healthcare Estimated Start Date: 06/23/2025Dress Code: NA **Only those lawfully authorized to work in the designated country associated with the position will be considered.** **Please note that all Position start dates and duration are estimates and may be reduced or lengthened based upon a client's business needs and requirements.** &nbspBenefits: For information and details on employment benefits offered with this position, please visit here . Should you have any questions/concerns, please contact our HR Department via our secure website . California Pay Equity: For information and details on pay equity laws in California, please visit the State of California Department of Industrial Relations' website here . Rose International is an Equal Opportunity Employer. All qualified applicants will receive consideration for employment without regard to race, color, religion, age, sex, sexual orientation, gender (expression or identity), national origin, arrest and conviction records, disability, veteran status or any other characteristic protected by law. Positions located in San Francisco and Los Angeles, California will be administered in accordance with their respective Fair Chance Ordinances. If you need assistance in completing this application, or during any phase of the application, interview, hiring, or employment process, whether due to a disability or otherwise, please contact our HR Department . Rose International has an official agreement (ID #132522), effective June 30, 2008, with the U.S. Department of Homeland Security, U.S. Citizenship and Immigration Services, Employment Verification Program (E-Verify). (Posting required by OCGA 13/10-91.).&nbsp

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Common Interview Questions And Answers

1. HOW DO YOU PLAN YOUR DAY?

This is what this question poses: When do you focus and start working seriously? What are the hours you work optimally? Are you a night owl? A morning bird? Remote teams can be made up of people working on different shifts and around the world, so you won't necessarily be stuck in the 9-5 schedule if it's not for you...

2. HOW DO YOU USE THE DIFFERENT COMMUNICATION TOOLS IN DIFFERENT SITUATIONS?

When you're working on a remote team, there's no way to chat in the hallway between meetings or catch up on the latest project during an office carpool. Therefore, virtual communication will be absolutely essential to get your work done...

3. WHAT IS "WORKING REMOTE" REALLY FOR YOU?

Many people want to work remotely because of the flexibility it allows. You can work anywhere and at any time of the day...

4. WHAT DO YOU NEED IN YOUR PHYSICAL WORKSPACE TO SUCCEED IN YOUR WORK?

With this question, companies are looking to see what equipment they may need to provide you with and to verify how aware you are of what remote working could mean for you physically and logistically...

5. HOW DO YOU PROCESS INFORMATION?

Several years ago, I was working in a team to plan a big event. My supervisor made us all work as a team before the big day. One of our activities has been to find out how each of us processes information...

6. HOW DO YOU MANAGE THE CALENDAR AND THE PROGRAM? WHICH APPLICATIONS / SYSTEM DO YOU USE?

Or you may receive even more specific questions, such as: What's on your calendar? Do you plan blocks of time to do certain types of work? Do you have an open calendar that everyone can see?...

7. HOW DO YOU ORGANIZE FILES, LINKS, AND TABS ON YOUR COMPUTER?

Just like your schedule, how you track files and other information is very important. After all, everything is digital!...

8. HOW TO PRIORITIZE WORK?

The day I watched Marie Forleo's film separating the important from the urgent, my life changed. Not all remote jobs start fast, but most of them are...

9. HOW DO YOU PREPARE FOR A MEETING AND PREPARE A MEETING? WHAT DO YOU SEE HAPPENING DURING THE MEETING?

Just as communication is essential when working remotely, so is organization. Because you won't have those opportunities in the elevator or a casual conversation in the lunchroom, you should take advantage of the little time you have in a video or phone conference...

10. HOW DO YOU USE TECHNOLOGY ON A DAILY BASIS, IN YOUR WORK AND FOR YOUR PLEASURE?

This is a great question because it shows your comfort level with technology, which is very important for a remote worker because you will be working with technology over time...

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