Customer Service Representative II - (Chesterfield, MO)

Description: Position Purpose\: Resolve customer inquiries via telephone and written communicationin a timely and appropriate manner Reference current materials to answer escalated and complex inquiries from members and providers regarding claims, eligibility, covered benefits and authorization status matters Provide assistance to members and/or providers regarding web siteregistration and navigation Educate members and/or providers on health plan initiatives Provide 1st call resolution working with appropriate internal/external resources, and ensure closure of all inquiries Document all activities for quality and metrics reporting through the Customer Relationship Management (CRM) application Process written customer correspondence and provide the appropriate level of follow-up in a timely manner Research and identify processing inaccuracies in claim payments and route to the appropriate team for claim adjustment Identify trends related to member and/or provider inquiries that may lead to policy or process