Position Description: IDRE Customer Service Representative (CSR) Reporting to the Independent Dispute Resolution Entity (IDRE) Stakeholder Engagement Subject Matter Expert, the Customer Service Representative (CSR) shall be in contact with Initiating Party and Non-initiating party stakeholders. The CSR shall be primarily responsible for efficiently answering inquiries telephonically and via email. The CSR shall record requests, collaborate with team members regarding inquires, triage urgent requests or concerns and provide follow-up of inquiries to ensure stakeholders concerns are efficiently and effectively prioritized. The IDRE CSR is responsible for escalating matters to the IDRE Stakeholder Engagement SME. The IDRE SCR documents inquiries and provides reporting to trend inquiries. Outcomes of documentation may be used for continuous quality improvement initiatives.Responsibilities
Understand and represent PRI™ mission, vision, and values to all internal and external customers
Interact with government and private sector clients, partners, and PRI™ staff in a professional and accountable manner, and as a representative of PRI™ management
Interact with project team members in order to successfully fulfill contract obligations with the highest quality and in a timely manner meeting PRITM's ISO requirements
Instills integrity throughout the organization via active participation in ISO requirements including but not limited to timely submission of Corrective Action Plans for all matters in which either PRITM standards and/or corporate contract standards have not been met. Communicates outcomes to team members to ensure a positive, open, environment which mitigates risk and achieves a culture of Continuous Quality Improvement
Engage clients in appropriate communication that manages client expectations and builds a collaborative relationship with the client
Respond to telephone inquiries promptly, professionally, and efficiently to provide first call resolution
Understand and resolve customer requests, questions and provide analysis of situations to determine best use of resources
Obtain, evaluate and analyze all relevant information to successfully handle inquires
Serves as liaison between the customer and various departments or team members in response to inquires
Direct unresolved issues to designated departments or team members for further investigation if necessary
Participation in educating and communicating the program requirements to stakeholders
Respond to all written inquires (letter, fax, and email) in a professional manner
Keep records of stakeholder interactions and transactions
Record details of actions taken and provide follow-up and results orientation based upon established protocols
Identification of analysis of trends and reporting to management team
Maintain a communications log that documents all inquiries, including telephonic, written, and e-mail
Actively participates in quality assurance activities; identifies trends and reports to management team
Recommend process improvement to management team (Lessons learned & Best Practices)
Maintain a high level of knowledge and comply with all protocols, policies and procedures
File all project documents (hard and soft copies)
Provide assistance as needed to team members
Perform other duties as assigned
Requirements:
Associates Degree with a minimum of two (2) years general related experience in lieu of a degree, 2 additional years of related experience is required.
Ability to work in a high volume and high pressured call center
Familiarity with Current Procedural Terminology (CPT) codes, International Classification of Diseases, Ninth Revision, Clinical Modification (ICD-9-CM) codes, and Healthcare Common Procedural Coding System (HCPCS) codes
andidates having experience with IDR, No Surprises Act or experience working in a customer service capacity with a health insurance company are preferred.
Excellent communication skills, both verbal and written. Ability to speak clearly in a professional manner so the stakeholder can understand and comprehend the interview/survey questions
Possesses high level of time management and organizational skills
Must have excellent customer service, interpersonal, listening, and problem-solving skills
Consistently handles inquiries in the friendly and professional manner
Reliable, honest, and trustworthy; Integrity is required
Demonstrated ability to work with others in a team environment
Excellent data entry skills with high level of accuracy; able to work under production guidelines
Must be proficient in Microsoft Applications such as MS Word, Excel, and Access
Demonstration of adherence to deadlines
Flexibility to changing requirements and contingencies
Willing to take on additional tasks as required and learn new skills
Willingness and ability to undertake training needed in order to fulfill the changing requirements of the job
Ability to interface with all levels of management and staff personnel
Must have no conflict of interest (COI) as defined in 1154(b)(1) of the Social Security Act (SSA)
Ability to obtain and maintain U.S. Government Security Clearance
Preference will be given to individuals who reside in, or are willing to relocate to, a recognized HUBZone area. (Go to http://map.sba.gov/hubzone/maps/ for more information).FLSA status: ExemptThe PRI Team Member Compensation Plan is applicable to this positionPRI is an equal employment opportunity employer. All qualified applicants including Disability/Vets or other qualified applicants will receive consideration for employment without regard to race, color, religion, gender, national origin, disability status, protected veteran status or any other characteristic protected by law.Qualified candidates may apply by clicking, "Apply Now". Next, submit your resume. You may complete a cover letter on the following screen. You must contact the employer via one of the methods listed on the screen after clicking "Apply for this job". Please be sure to identify PA CareerLink as your referral source.