Job Description

Customer Service Representative CSR

Reporting to the Independent Dispute Resolution Entity (IDRE) Stakeholder Engagement Subject Matter Expert, the Customer Service Representative (CSR) shall be in contact with Initiating Party and Non-initiating party stakeholders. The CSR shall be primarily responsible for efficiently answering inquiries telephonically and via email. The CSR shall record requests, collaborate with team members regarding inquiries, triage urgent requests or concerns and provide follow-up of inquiries to ensure stakeholders concerns are efficiently and effectively prioritized. The IDRE CSR is responsible for escalating matters to the IDRE Stakeholder Engagement SME. The IDRE SCR documents inquiries and provides reporting to trend inquiries. Outcomes of documentation may be used for continuous quality improvement initiatives.

Responsibilities

• Understand and represent PRI mission, vision, and values to all internal and external customers
• Interact with government and private sector clients, partners, and PRI staff in a professional and accountable manner, and as a representative of PRI management
• Interact with project team members in order to successfully fulfill contract obligations with the highest quality and in a timely manner meeting PRI ISO requirements
• Instills integrity throughout the organization via active participation in ISO requirements including but not limited to timely submission of Corrective Action Plans for all matters in which either PRI standards and/or corporate contract standards have not been met. Communicates outcomes to team members to ensure a positive, open, environment which mitigates risk and achieves a culture of Continuous Quality Improvement
• Engage clients in appropriate communication that manages client expectations and builds a collaborative relationship with the client
• Respond to telephone inquiries promptly, professionally, and efficiently to provide first call resolution
• Understand and resolve customer requests, questions and provide analysis of situations to determine best use of resources
• Obtain, evaluate and analyze all relevant information to successfully handle inquires
• Serves as liaison between the customer and various departments or team members in response to inquires
• Direct unresolved issues to designated departments or team members for further investigation if necessary
• Participation in educating and communicating the program requirements to stakeholders
• Respond to all written inquires (letter, fax, and email) in a professional manner
• Keep records of stakeholder interactions and transactions
• Record details of actions taken and provide follow-up and results orientation based upon established protocols
• Identification of analysis of trends and reporting to management team
• Maintain a communications log that documents all inquiries, including telephonic, written, and e-mail
• Actively participates in quality assurance activities; identifies trends and reports to management team
• Recommend process improvement to management team (Lessons learned & Best Practices)
• Maintain a high level of knowledge and comply with all protocols, policies and procedures
• File all project documents (hard and soft copies)
• Provide assistance as needed to team members
• Perform other duties as assigned

Requirements:

• Associates Degree with a minimum of two (2) years general related experience in lieu of a degree, 2 additional years of related experience is required.
• Ability to work in a high volume and high pressured call center
• Familiarity with Current Procedural Terminology (CPT) codes, International Classification of Diseases, Ninth Revision, Clinical Modification (ICD-9-CM) codes, and Healthcare Common Procedural Coding System (HCPCS) codes
• Candidates having experience with IDR, No Surprises Act or experience working in a customer service capacity with a health insurance company are preferred.
• Excellent communication skills, both verbal and written. Ability to speak clearly in a professional manner so the stakeholder can understand and comprehend the interview/survey questions
• Possesses high level of time management and organizational skills
• Must have excellent customer service, interpersonal, listening, and problem-solving skills
• Consistently handles inquiries in the friendly and professional manner
• Reliable, honest, and trustworthy; Integrity is required
• Demonstrated ability to work with others in a team environment
• Excellent data entry skills with high level of accuracy; able to work under production guidelines
• Must be proficient in Microsoft Applications such as MS Word, Excel, and Access
• Demonstration of adherence to deadlines
• Flexibility to changing requirements and contingencies
• Willing to take on additional tasks as required and learn new skills
• Willingness and ability to undertake training needed in order to fulfill the changing requirements of the job
• Ability to interface with all levels of management and staff personnel
• Must have no conflict of interest (COI) as defined in 1154(b)(1) of the Social Security Act (SSA)
• Ability to obtain and maintain U.S. Government Security Clearance

Preference will be given to individuals who reside in, or are willing to relocate to, a recognized HUBZone area. (Go to for more information).

FLSA status: Non-exempt

The PRI Team Member Compensation Plan is applicable to this position

PRI is an equal employment opportunity employer. All qualified applicants including Disability/Vets or other qualified applicants will receive consideration for employment without regard to race, color, religion, gender, national origin, disability status, protected veteran status or any other characteristic protected by law.

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