Customer Care Representative I

TITLE: CUSTOMER CARE REPRESENTATIVE I

POSITION SUMMARY:

The Customer Care Representative 1 provides courteous, accurate, and timely responses to routine employee benefits inquiries via phone, email, and chat from members and providers. This role involves handling standard inquiries and following up as needed, with support from senior representatives for complex issues. Bilingual proficiency (Spanish) is a plus. Individuals who thrive at First Choice Health exhibit the following success skills-- Caring, Transparency, Collaboration, Relentlessness, and Innovation.

RESPONSIBILITIES:

• Phone and Queue Management: Handle all assigned routine inquiries regarding benefits, eligibility, claims, and provider/facility locations within the network.
• Customer Assistance: Answer member and provider calls about employee benefits and eligibility, claims payment and processing status.
• Issue Escalation: Route challenging or complex inquiries, especially emotional or difficult calls, to Customer Care Representative II or Senior.
• Documentation: Log each customer interaction and resolution in the Customer Relationship Management (CRM) system and track action items related to the interaction as needed.
• Standards and Compliance: Meet key performance indicators (KPIs) for response time, accuracy, and adherence to call schedules, while ensuring compliance with confidentiality guidelines for Protected Health Information (PHI).
• Support and Teamwork: Support team goals by handling calls within the queue efficiently and escalating issues appropriately.
• Chat Support: Manage one or more chat sessions at a time to assist with basic customer inquiries.
  
  
  

QUALIFICATIONS:

• High School Diploma or equivalent.
• 2+ years in customer service or similar role, with experience in healthcare or insurance preferred.
  
  
  

SKILLS:

• Has customer service phone skills.
• Strong written and verbal communication skills and an empathetic approach to customer service.
• Basic understanding of employee healthcare benefits and provider networks.
• Effective time management, prioritization and multitasking skills
• Competency with CRM systems, Google Workspace, and Microsoft Office Suite.
• Ability to work collaboratively in a team and seek guidance as needed.
  
  
  

PHYSICAL REQUIREMENTS:

• Ability to see and hear within normal ranges with or without aid.
• Ability to bend, and move within normal ranges.
• Ability to be stationary for long periods of time.
• Finger and hand dexterity.
• Able to lift a minimum of 10-20 pounds.
  
  
  

ACCESS TO PHI:

Routine & re-occurring access to all forms of PHI - The duties of the position require

regular and unrestricted contact with PHI.

Pay Range: $19 - $20 hourly

Diversity, Equity & Inclusion:

At First Choice Health we are thoughtful about the words we use and the actions we take.We intentionally hire people from diverse backgrounds who help us think differently and challenge status- quo thinking. Our commitment to Diversity, Equity, and Inclusion allow us to strive to make healthcare easier to access for everyone in all walks of life.

Benefits:

• Medical & Vision- We offer two medical plans for employees, High Deductible and PPO plan for employees to choose from.
• Dental- A dental plan through Sun Life dental is available to employees and eligible dependents.
• Health Savings Account (HSA)- Employees who enroll in our medical plan can choose to establish a health savings account if eligible. FCH makes contributions to the HSA and employees may contribute pre-tax dollars via payroll deduction up to the IRS allowable limits.
• Flexible Spending Account (FSA)- Employees may contribute pre-tax dollars through payroll deduction to a limited vision/dental FSA. Unlike with an HSA, unused FSA funds do not rollover from year to year.
• Life Insurance- FCH provides life insurance benefits at no cost at a limit of two times an employee's annual base salary (with a max of $300,000). Employees have the opportunity to purchase additional life insurance for themselves and their dependents through payroll deduction.
• Short & Long-Term Disability Insurance- FCH provides long-term and short-term disability coverage to all employees. It is a shared cost benefit where FCH pays for the long-term benefit and employees pay for the short-term benefit.
• Personal Leave and Sick Time- FCH employees enjoy the benefit of paid time off. Vacation, sick leave, and any personal leave are combined into a general annual PTO bank. PTO accruals are based on service on a pay period: 0-1 year of service - 120 hours; 1-2 years of service - 136 hours; 3+ years of service - 168 hours.
• Paid Holidays- Each employee receives 13 paid holidays. 16 hours per year are available for community services, usable in four-hour or eight-hour time blocks.
• Employee Assistance Program (EAP)- FCH recognizes that a variety of problems can disrupt personal and work life. If an employee needs professional help, they can contact the EAP, which provides confidential access to professional counseling services for help in confronting personal problems such as alcohol/substance abuse, marital and family difficulties, financial or legal troubles, or emotional distress.
• Retirement Plan 401(k)- We contribute 50% of the employee's 401k deferral, up to a maximum of 3% of the employee's gross salary. Eligible employees must be at least 21
  
  
  

years old, and be employed with FCH a minimum of 90 days.

• Profit Sharing - FCH may make annual discretionary profit sharing contributions in an amount to be determined at Plan Year end.
• Tuition Reimbursement - Employees may be eligible to receive reimbursement for continuing education for Bachelor's program after one year of employment with the company.
• Wellness- We encourage and promote healthy behaviors through a Wellness program that offers rewards for those that participate.
• These benefits may be changed with or without notice at any given time.
  
  
  

For California employees, please review Privacy Act: https://www.fchn.com/documents/fch/pdf/caprivacynoticeemployeesandapplicantsfinal8-23- 20231.pdf