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Core Competencies
Role fitCore Competencies
Use this summary to align your resume positioning with the role.
Demonstrates strong customer service skills with a focus on customer satisfaction and retention. Capable of resolving claims issues and providing education and support to team members and customers.
Highest-signal resume keywords
Customer Service ExperienceCommunication SkillsClaims ResolutionProcess ImprovementTeam-Building Resources
ATS Keywords
Tailor your resumeApplicant Tracking System Keywords
Tip: use these terms in your resume and cover letter to boost ATS matches.
Hard Skills
Claims ReviewBenefits DeterminationProcess ImprovementCross-Training Participation
Soft Skills
Customer Retention SkillsProblem-Solving Skills
Certifications & Qualifications
High School DiplomaGED
Industry Keywords
Customer SatisfactionCustomer ConcernsSuspended ClaimsPolicies and ProceduresPennsylvania Residency
About the role
Key responsibilities & impact- Assist in resolving customer concerns
- Provide appropriate education and instruction
- Maintain customer satisfaction through high-level customer service in a primary function
- Participate in cross-training
- Improve processes within the Customer Service team
- Determine whether services received are covered benefits based on line of business and product design
- Review suspended claims and resolve them using current policies, procedures, and applicable benefits
- Provide team-building resources to direct peers to appropriate claims resolution policies and procedures
- Provide daily support and advice to member and provider services staff regarding claims issues
- Research claim issues from participating providers
- Identify criteria for reconsideration for payment
Requirements
What you’ll need- High School Diploma or Equivalent (GED) (Required)
- Minimum of 1 year of customer service experience (Required)
- Communication skills
- Customer retention skills
- Customer service skills
- Pennsylvania residency
- Ability to work 40 scheduled hours per week
- Ability to work day shifts
- Must comply with organization policies and procedures
Benefits
Comp & perks- Healthcare benefits for full-time and part-time positions from day one
- Vision coverage
- Dental coverage
- Domestic partner benefits
- Collaborative, cooperative, and collegial work atmosphere