Western Growers
Western Growers Health─
a part of Western Growers Family of Companies─provides employer-sponsored health benefit plans to meet the needs of those working for the agriculture industry. The unmatched benefit options provided by Western Growers Health stem from the core mission of Western Growers Association (est. 1926) to support the business interests of employers in the agriculture industry.
Our mission at Western Growers Health is to deliver value to employers by offering robust health plans that meet the needs of a diverse workforce. By working at Western Growers Health, you will join a dedicated team of employees who care about offering quality health benefits and excellent customer service to plan participants. If you want to start making a difference working in the health care industry, then apply to Western Growers Health today!
Compensation: $46,669.19 - $65,668.60 with a rich benefits package that includes profit-sharing.
Job Description Summary This position reports to the Supervisor, Service Optimization. The Customer Service Specialist plays a critical role in supporting customers by handling a wide range of inquiries from internal teams, external customers, members and healthcare providers. This position is responsible for delivering high-quality service and driving first-call resolution across topics including eligibility, FSA/HRA/HSA claims, prescription claims, medical, and dental claims, as well as COBRA-related questions. The specialist also supports health management functions by collecting participant information, scheduling appointments, and conducting outbound calls. Additionally, the role includes assisting with simple claims adjustment inquiries, ensuring accurate and timely responses that enhance the overall customer experience.
Qualifications
High School diploma or GED and/or five (5) to seven (7) years of experience in a healthcare customer service call center, with strong knowledge of company services, products, insurance benefits, provider contracts and claims preferred.
Excellent verbal and written communication skills, including a clear concise speaking voice.
Proficient in learning new software and navigating multiple systems simultaneously.
Advanced keyboarding skills, and database management skills.
Excellent judgement, negotiation skills, and ability to work independently.
Strong ability to research and resolve technical issues and/or client problems as they arise with minimal direction.
Fluent in English (oral and written) required. Bilingual in Spanish preferred.
Excellent knowledge of health claims processing (Medical, Dental, FSA, HRA, HSA, RX) as well as understanding of the application of benefit contracts, pricing, processing, policies, and procedures preferred.
Ability to interpret Plan Documents and/or Summary Plan Descriptions (SPD) for the purpose of accurate claim adjudication and/or benefit determination preferred.
Strong understanding of regulatory requirements, including ACA, HIPAA, ERISA and COBRA.
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
Address complex customer inquiries through telephone, email, chat, Short Message Service (SMS), and written correspondence, covering topics such as insurance benefits, provider contracts, eligibility, and claims, ensuring confidentiality, professionalism, and ethical standards.
Champion customer-centricity by actively listening to member concerns, empathizing with their experiences, and advocating for solutions that prioritize their needs and satisfaction.
Manage average handle time (AHT) to meet performance targets without compromising service quality or customer satisfaction.
Participate in ongoing training and development to stay current on product updates, policy changes, and best practices in customer service.
Utilize administrative processing system, imaging systems, and all systems necessary to obtain and extract information effectively.
Develop and maintain positive internal customer relationships, coordinating across departments to resolve requests appropriately and promptly.
Adhere to quality guidelines to provide exceptional customer support and ensure scores meet or exceed expectations.
Operations Support
Continuously seek opportunities to enhance the customer journey by identifying pain points and recommending process improvements that deliver seamless, empathetic, and resolution-focused support experiences.
Document customer interactions and outcomes thoroughly and accurately for tracking and analysis.
Meet or exceed all department and performance service metrics.
Provide education and assistance to WGAT and PCMI internal employees, clients and COBRA Participants relative to Federal and State COBRA laws/regulations, funding and payments.
Research and correct cash application issues in the administrative processing system. Determine out of balance ledger items on accounts. Contact subscribers to explain and to resolve billing/payment discrepancies. Verify refunds for terminations and/or overpayments.
Support health management functions by collecting participant information, scheduling appointments, and conducting outbound calls.
Support with adjudication of medical and dental claims related to customer or client escalations.
Conduct research and assist in resolving inquiries related to prescription claim discrepancies and processing.
Investigate and address customer concerns involving FSA, HRA, and HSA products, ensuring accurate information and timely resolution.
Research, resolve and respond to all correspondence and internal escalated communications (Ops Connect) for enterprise accounts.
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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a part of Western Growers Family of Companies─provides employer-sponsored health benefit plans to meet the needs of those working for the agriculture industry. The unmatched benefit options provided by Western Growers Health stem from the core mission of Western Growers Association (est. 1926) to support the business interests of employers in the agriculture industry.
Our mission at Western Growers Health is to deliver value to employers by offering robust health plans that meet the needs of a diverse workforce. By working at Western Growers Health, you will join a dedicated team of employees who care about offering quality health benefits and excellent customer service to plan participants. If you want to start making a difference working in the health care industry, then apply to Western Growers Health today!
Compensation: $46,669.19 - $65,668.60 with a rich benefits package that includes profit-sharing.
Job Description Summary This position reports to the Supervisor, Service Optimization. The Customer Service Specialist plays a critical role in supporting customers by handling a wide range of inquiries from internal teams, external customers, members and healthcare providers. This position is responsible for delivering high-quality service and driving first-call resolution across topics including eligibility, FSA/HRA/HSA claims, prescription claims, medical, and dental claims, as well as COBRA-related questions. The specialist also supports health management functions by collecting participant information, scheduling appointments, and conducting outbound calls. Additionally, the role includes assisting with simple claims adjustment inquiries, ensuring accurate and timely responses that enhance the overall customer experience.
Qualifications
High School diploma or GED and/or five (5) to seven (7) years of experience in a healthcare customer service call center, with strong knowledge of company services, products, insurance benefits, provider contracts and claims preferred.
Excellent verbal and written communication skills, including a clear concise speaking voice.
Proficient in learning new software and navigating multiple systems simultaneously.
Advanced keyboarding skills, and database management skills.
Excellent judgement, negotiation skills, and ability to work independently.
Strong ability to research and resolve technical issues and/or client problems as they arise with minimal direction.
Fluent in English (oral and written) required. Bilingual in Spanish preferred.
Excellent knowledge of health claims processing (Medical, Dental, FSA, HRA, HSA, RX) as well as understanding of the application of benefit contracts, pricing, processing, policies, and procedures preferred.
Ability to interpret Plan Documents and/or Summary Plan Descriptions (SPD) for the purpose of accurate claim adjudication and/or benefit determination preferred.
Strong understanding of regulatory requirements, including ACA, HIPAA, ERISA and COBRA.
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
Address complex customer inquiries through telephone, email, chat, Short Message Service (SMS), and written correspondence, covering topics such as insurance benefits, provider contracts, eligibility, and claims, ensuring confidentiality, professionalism, and ethical standards.
Champion customer-centricity by actively listening to member concerns, empathizing with their experiences, and advocating for solutions that prioritize their needs and satisfaction.
Manage average handle time (AHT) to meet performance targets without compromising service quality or customer satisfaction.
Participate in ongoing training and development to stay current on product updates, policy changes, and best practices in customer service.
Utilize administrative processing system, imaging systems, and all systems necessary to obtain and extract information effectively.
Develop and maintain positive internal customer relationships, coordinating across departments to resolve requests appropriately and promptly.
Adhere to quality guidelines to provide exceptional customer support and ensure scores meet or exceed expectations.
Operations Support
Continuously seek opportunities to enhance the customer journey by identifying pain points and recommending process improvements that deliver seamless, empathetic, and resolution-focused support experiences.
Document customer interactions and outcomes thoroughly and accurately for tracking and analysis.
Meet or exceed all department and performance service metrics.
Provide education and assistance to WGAT and PCMI internal employees, clients and COBRA Participants relative to Federal and State COBRA laws/regulations, funding and payments.
Research and correct cash application issues in the administrative processing system. Determine out of balance ledger items on accounts. Contact subscribers to explain and to resolve billing/payment discrepancies. Verify refunds for terminations and/or overpayments.
Support health management functions by collecting participant information, scheduling appointments, and conducting outbound calls.
Support with adjudication of medical and dental claims related to customer or client escalations.
Conduct research and assist in resolving inquiries related to prescription claim discrepancies and processing.
Investigate and address customer concerns involving FSA, HRA, and HSA products, ensuring accurate information and timely resolution.
Research, resolve and respond to all correspondence and internal escalated communications (Ops Connect) for enterprise accounts.
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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