Job Summary: Develop basic knowledge and skill required to resolve routine inquiries from QUEST members, providers, or internal departments. Within twelve (12) months, demonstrate the ability to conduct the required research on member benefits, provider inquires, QUEST policies to include payment policies. Provide considerate, thorough and accurate responses to members and providers while meeting all performance measures.
Duties and Responsibilities:
Successfully complete on the job training:
Ulysses Learning Call Strategy Training,
Overview of the QUEST program and policies,
Claims processing basics,
Multiple applications and resources,
Inventory management practices,
Customer experience and other performance measures.
Review, document, and accurately respond, verbally or in writing, to basic inquiries received by telephone, correspondence or internal communication, as assigned by supervisor.
Effectively manage unresolved inquiries to provide timely follow-up and accurate resolution to customers by:
Identifying issues and compiling supporting documentation necessary for Management and other internal department review.
Participate in routine analysis of the root cause for customer inquiries.
Perform other duties as assigned:
Innovation, process improvement activities,
Complete or participate in corporate training, compliance certification or initiatives as directed by management.
One year of technical school or business related training and 1 year of work experience or equivalent combination of education and work experience.
Excellent verbal communications skills.
Clear and concise written communications skills using proper English grammar.
Basic working knowledge of standard office equipment to include calculator, copier, and facsimile machine.
Basic keyboard and typing skills with low error rate.
Basic knowledge and able to use word processing applications.
Ability to multitask and handle various functions in a timely manner.
Basic working knowledge of Microsoft Office applications, may include but not limited to Outlook, Word, and Excel.
Overtime may be required to meet business needs.