CCSB Call Center Representative I

If you’re looking for a career that provides affordable health benefit solutions to the people who support some of the most vital industries, we’re looking for you.      

         

At Pinnacle Claims Management, we are an innovative third-party administrator (TPA) that provides a full-suite of comprehensive and customized health benefits administration services for self-funded companies, including health management and wellness solutions, and pharmacy benefit management. As part of the Western Growers Family of Companies, we are committed to providing our employees with everything they need to succeed and grow. We know that taking care of our clients starts with taking care of our employees.               

As a keystone of our philosophy, we recognize that every person on our team comes to us with a unique background, history and story that adds strength to our organization. Additionally, employees are encouraged to recognize that there isn’t a work life and a home life, there is one life. This recognition throughout the organization emphasizes the value of finding a healthy and happy balance in every employee’s life. One way this is realized for employees of Pinnacle Claims Management is flexible work arrangements with work-from-home, in-office or hybrid options.               

With competitive compensation packages, premier investment support, enriching personal development and more, we strive for our employees’ job satisfaction and success.             

           

Job Description Summary

Position reports directly to the Supervisor, Pinnacle Small Business Call Center (CCSB). This position provides consultative telephonic and web-based assistance to Agents, Certified Enrollment Counselors, Qualified Health Plans (QHP), federal and state agencies and other stakeholders in Health Benefit Exchange administration. The incumbent will provide customer service support to clients by instructing them on correct eligibility management procedures and troubleshoot application issues and concerns.           

Qualifications

High School diploma or GED and one (1) to three (3) years of experience in customer service within a call center environment, preferably within a technical support role.

Experience in the healthcare industry especially with a health benefits company or a federal, state benefit program a plus.

Knowledge of Health Benefits Exchange (HBEX), eligibility requirements and the application and enrollment processes preferred.

Strong written and verbal communication skills. including a very clear and concise speaking voice, and active listening.

Demonstrated skills in time management and team building.

Strong ability to research and resolve technical issues and/or client problems as they arise with minimal direction.

Knowledge of government regulations, federal, state, and local health benefit programs preferred.

Ability to retain and apply knowledge of the various operations of the organization, products, and services, in order to provide excellent customer service support

Ability to learn new software and navigate multiple systems at once. Must have strong knowledge of Customer Relationship Management (CRM) software.

Ability to adapt to a constantly changing environment.

Basic computer experience and keyboarding skills.

Bilingual in Spanish, Chinese, Korean, and Vietnamese is a plus.

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 steps taken to protect company information (e.g., facing computer towards wall, etc.) 

A functioning smoke detector, fire extinguisher, and first aid kit on site. 

Duties And Responsibilities

Customer Advocate           

Foster and build working relationships with Agents, Certified Enrollment Counselors, federal and state agency contacts.

Must become the subject matter expert for PCMI, State Provided Programs and HealthCare.Gov.

Serve as a representative of the Agent by displaying professionalism, knowledge, and discretion in all interactions with other members of the Agent’s community and their customers.

Adhere to the call center Quality Guidelines to ensure the best phone support to our callers.

Call Center Support           

Be a key contributor to meeting our contractual obligations to PCMI.

Meet and maintain all of the department service metrics and performance objectives.

Thoroughly document information, activities and changes in the database and inquiry outcomes for accurate tracking and analysis.

Provide telephonic and web-based outreach to provide informational support to assist with all aspects of the application process within the Covered California systems from sign up to termination.

Identify, initiate, and implement at least one process improvement and/or innovation annually.

Other           

Utilize all capabilities to satisfy one mission — to enhance the competitiveness and profitability of our members. Do everything possible to help members succeed by being curious and striving to understand what others are trying to achieve, planning, and executing work helpfully and collaboratively. Be willing to adjust efforts to ensure that work and attitude are helpful to others, be self-accountable, create a positive impact, and be diligent in delivering results.

Maintain internet speed of 40 MB download and 10 MB upload and router with wired Ethernet. 

Maintain a HIPAA-compliant workstation and utilize appropriate security techniques to ensure HIPAA-required protection of all confidential/protected client data. 

Maintain and service safety equipment (e.g., smoke detector, fire extinguisher, first aid kit). 

All other duties as assigned

Physical Demands/Work Environment

The physical demands and work environment described here represent those that an employee must meet to successfully perform this job’s essential functions. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions. While performing the duties of this job, the employee is regularly required to communicate with others. The employee frequently is required to move around the office. The employee is often required to use tools, objects, and controls. This noise level in the work environment is usually moderate.   

 

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