Senior Customer Service Representative Absence Management (Hybrid in Maryland)

CNSI and Kepro are now Acentra Health! Acentra Health exists to empower better health outcomes through technology, services, and clinical expertise. Our mission is to innovate health solutions that deliver maximum value and impact.

Lead the Way is our rallying cry at Acentra Health. Think of it as an open invitation to embrace the company’s mission, actively engage in problem-solving, and take ownership of your work daily. Acentra Health offers you unparalleled opportunities. In fact, you have all you need to take charge of your career and accelerate better outcomes – making this a great time to join our team of passionate individuals dedicated to being a vital partner for health solutions in the public sector.

Acentra seeks a Senior Customer Service Representative to join our growing team. 

Job Summary:

As a Senior Customer Service Representative, you will be a key player in our team, delivering exceptional service and guidance to both members and providers. Your role will involve handling incoming calls with expertise, addressing inquiries about eligibility, benefits, claims, and service authorizations. You will also ensure accurate and timely entry of intake documentation into our systems. By leveraging your deep understanding of program policies and procedures, you will contribute significantly to a seamless and positive experience for our clients and partners.

Job Responsibilities:

• Accurately respond to inbound phone calls and processing provider and member inquirie and requests into the appropriate system and database.
• Independently resolve customers’ service or billing complaints by demonstrating sound judgement.
• Contact customers to respond to complex inquiries or to notify them of claim investigation results and any planned adjustments.
• Independently resolve customer administrative concerns as the first line of contact - this may include claim resolutions and other expressions of dissatisfaction.
• Refer unresolved customer grievances, appeals, and claim resolution to designated departments for further investigation.
• Keep records of customer interactions and transactions, recording details of inquiries, complaints, and comments, as well as actions taken.
• Actively listens and probes callers in a professional and timely manner to determine purpose of the calls.
• Independently research and articulately communicate information regarding member eligibility, benefits, services, claim status, and authorization inquiries to callers while maintaining confidentiality.
• Assist efforts to continuously improve by assuming responsibility for identifying and bringing to the attention of responsible entities operations problems and/or inefficiencies.
• Assist in the mentoring and training of new staff.
• Assume full responsibility for self-development and career progression; proactively seek and participate in ongoing training sessions (formal and informal).
• Educate providers on how to submit claims and when/where to submit a treatment plan.
• Independently perform necessary follow-up tasks to ensure member or provider needs are completely met.
• Support team members and participate in team activities to help build a high-performance team.
• Document customers' comments/information and forwards required information to the appropriate staff. § Escalate calls to Call Center Lead when necessary.

Required Qualifications/Experience:

• Requires a High School diploma or equivalent.
• Requires minimum of 3 to 5 years of customer service experience.
• Medical terminology courses and Health insurance industry is preferred.
• Effective verbal and listening skills to provide courteous and professional customer service.
• Effective PC skills including electronic mail, intranet and industry standard application.
• Demonstrates the ability to identify and resolve problems in a timely manner; effectively gathers and analyzes information; excels in group problem-solving situations; maintains a calm and composed demeanor in challenging situations.
• Responds promptly to customer needs; actively seeks customer feedback to enhance service quality; consistently meets service and assistance commitments.
• Speaks clearly and persuasively in both positive and negative situations; actively listens and seeks clarification when needed.
• Contributes positively to team efforts and helps build a cohesive team spirit.
• Proficient in Microsoft software applications including Word, Excel, PowerPoint, and Access.
• Bilingual Spanish-English a plus.

Why us

We are a team of experienced and caring leaders, clinicians, pioneering technologists, and industry professionals who come together to redefine expectations for the healthcare industry. State and federal healthcare agencies, providers, and employers turn to us as their vital partner to ensure better healthcare and improve health outcomes. 

We do this through our people

You will have meaningful work that genuinely improves people's lives nationwide. Our company cares about our employees, giving you the tools and encouragement, you need to achieve the finest work of your career. 

Thank You!

We know your time is valuable and we thank you for applying for this position. Due to the high volume of applicants, only those who are chosen to advance in our interview process will be contacted. We sincerely appreciate your interest in Acentra Health and invite you to apply to future openings that may be of interest. Best of luck in your search!

~ The Acentra Health Talent Acquisition Team

EOE AA M/F/Vet/Disability

Acentra Health is an Equal Opportunity Employer. All qualified applicants will receive consideration for employment without regard to race, color, religion, sex, sexual orientation, gender identity, national origin, disability, status as a protected veteran or any other status protected by applicable Federal, State or Local law.

Benefits

Benefits are a key component of your rewards package. Our benefits are designed to provide you with additional protection, security, and support for both your career and your life away from work. Our benefits include comprehensive health plans, paid time off, retirement savings, corporate wellness, educational assistance, corporate discounts, and more.

Compensation

The compensation for this role is $19.00 per hour.

Based on our compensation program, an applicant’s position placement in the pay range will depend on various considerations, such as years of applicable experience and skill level.

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