Customer Service Representative I (Pacific/Mountain Time zone Based)

Position Overview

Western Growers Health, a part of Western Growers Family of Companies, provides employer-sponsored health benefit plans to meet the needs of those working in the agriculture industry. The unmatched benefit options stem from the core mission of Western Growers Association (est. 1926) to support the business interests of agriculture employers. Our mission is to deliver value by offering robust health plans that serve a diverse workforce. Under the direction of the Senior Supervisor, Customer Service, you will respond to customer inquiries regarding insurance benefits, provider contracts, eligibility, and claims while researching and analyzing data to address operational challenges.

Compensation: $35,288.33 - $50,874.31 with a rich benefits package that includes profit-sharing.

Key Responsibilities

• Customer Advocate:
  • Respond to general customer questions via telephone, e-mail, and written correspondence regarding insurance benefits, provider contracts, eligibility, and claims in a confidential, professional, and ethical manner.
  • Analyze problems and provide information/solutions.
  • Research and resolve aged Customer Service open calls within company standards.
  • Operate in the Health Care Processing System (HCPS), imaging systems, and all necessary systems to obtain and extract information.
  • Develop and maintain positive customer relations and coordinate with various company functions to ensure timely handling of customer requests and questions.
  • Be accountable for identifying issues or trends and assisting in reporting, improvement, and corrective actions.
• Call Center Support:
  • Thoroughly document information, activities, and changes in the database, including inquiry outcomes, for accurate tracking and analysis.
  • Research and analyze data to address operational challenges and customer service issues.
  • Provide external and internal customers with requested information, including assistance with difficult and upset customers.
  • Meet and maintain quality and telephone performance measures as per the Customer Service Performance Report.
  • Communicate with appropriate departments to identify and resolve service issues.
  • Identify inefficiencies within established processes and suggest potential solutions to save time, reduce risk, and minimize expenses.
  • Create and document at least one new Standard Operating Procedure (SOP) annually.
  • Initiate and implement at least one process improvement or innovation each year.
• Other:
  • Maintain regular attendance as outlined in the employee handbook.
  • Utilize all capabilities to enhance the competitiveness and profitability of our members by being curious, understanding their goals, and executing work collaboratively and helpfully.
  • Ensure internet speed of 40 MB download and 10 MB upload with a router using wired Ethernet.
  • Maintain a HIPAA-compliant workstation and employ proper security techniques to protect confidential and protected client data.
  • Maintain and service safety equipment such as smoke detectors, fire extinguishers, and first aid kits.
  • Perform all other duties as assigned.

Required Qualifications

• Good communication and telephone skills with a very clear and concise speaking voice.
• Proficient written communication skills with the ability to learn new software and navigate multiple systems concurrently.
• Moderate computing and keyboarding skills, including proficiency with database management.
• Ability to adapt to a constantly changing environment.
• Proficient organizational and time management skills.
• Fluent in English (oral and written) required.
• Internet access provided by a cable or fiber provider with 40 MB download and 10 MB upload speeds.
• Home router with wired Ethernet (wireless connections and hotspots are not permitted).
• A designated room for your office or measures taken to protect company information (e.g., facing the computer towards a wall).
• A functioning smoke detector, fire extinguisher, and first aid kit on site.

Preferred Qualifications

• High School diploma or GED and a minimum of two (2) years of experience in customer service within a call center environment, preferred.
• Knowledge of health benefits and eligibility, preferred.
• Bilingual in Spanish, preferred.

Benefits & Perks

• Benefits: Rich benefits package that includes profit-sharing.