TakeCare Insurance Company, Inc.
Customer Service Specialist
TakeCare Insurance Company, Inc., Simi Valley, California, United States
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Customer Service Specialist
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TakeCare Insurance Company, Inc.
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Job Summary As a Customer Service Specialist, you will play a pivotal role in enhancing customer satisfaction and business productivity. Reporting directly to the Customer Service Supervisor, you will be responsible for receiving, documenting, and resolving escalated member inquiries, complaints, appeals, and grievances. You will gather and present all relevant data of case for medical review and will make recommendations for resolution and/or determination of next step. Also responsible for coordinating problem resolution for members, providers, and employer groups amongst various internal departments and external contacts.
Essential Duties And Responsibilities
Serve as liaison between customer service team, management, and customers to improve service and productivity.
Analyze complaints and provide corrective actions.
Assist in training peers on customer service improvements.
Respond to member inquiries, complaints, appeals, and grievances.
Prepare and initiate correspondence related to inquiries and complaints.
Gather and present case data for medical review, making recommendations for resolution.
Coordinate problem resolution with internal departments and external contacts.
Authorize claims payments within pre-established guidelines.
Educate members on benefits, plan use, premiums, and claim statuses.
Notify providers of overturned appeals and financial responsibility changes.
Handle duties of the Coordinator as needed.
Act as a resource within the department, guiding staff on simple matters.
Collect and update member demographics.
Manage special projects like Grievance/Appeal Coordination.
Perform other duties as assigned.
Education & Experience
High school diploma or equivalent.
1 year experience in Customer Support.
Healthcare or clinic administration experience preferred but not required.
Strong interpersonal, communication, and problem-solving skills.
Ability to handle multiple tasks with independence and flexibility.
Knowledge of federal and state healthcare laws preferred.
Proficient in MS Office.
Additional Details
Seniority level: Entry level
Employment type: Full-time
Job function: Other
Industry: Hospitals and Health Care
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Customer Service Specialist
role at
TakeCare Insurance Company, Inc.
Get AI-powered advice on this job and more exclusive features.
Job Summary As a Customer Service Specialist, you will play a pivotal role in enhancing customer satisfaction and business productivity. Reporting directly to the Customer Service Supervisor, you will be responsible for receiving, documenting, and resolving escalated member inquiries, complaints, appeals, and grievances. You will gather and present all relevant data of case for medical review and will make recommendations for resolution and/or determination of next step. Also responsible for coordinating problem resolution for members, providers, and employer groups amongst various internal departments and external contacts.
Essential Duties And Responsibilities
Serve as liaison between customer service team, management, and customers to improve service and productivity.
Analyze complaints and provide corrective actions.
Assist in training peers on customer service improvements.
Respond to member inquiries, complaints, appeals, and grievances.
Prepare and initiate correspondence related to inquiries and complaints.
Gather and present case data for medical review, making recommendations for resolution.
Coordinate problem resolution with internal departments and external contacts.
Authorize claims payments within pre-established guidelines.
Educate members on benefits, plan use, premiums, and claim statuses.
Notify providers of overturned appeals and financial responsibility changes.
Handle duties of the Coordinator as needed.
Act as a resource within the department, guiding staff on simple matters.
Collect and update member demographics.
Manage special projects like Grievance/Appeal Coordination.
Perform other duties as assigned.
Education & Experience
High school diploma or equivalent.
1 year experience in Customer Support.
Healthcare or clinic administration experience preferred but not required.
Strong interpersonal, communication, and problem-solving skills.
Ability to handle multiple tasks with independence and flexibility.
Knowledge of federal and state healthcare laws preferred.
Proficient in MS Office.
Additional Details
Seniority level: Entry level
Employment type: Full-time
Job function: Other
Industry: Hospitals and Health Care
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