Customer Service Representative I

    The Customer Service Representative is responsible for increasing customer satisfaction and retention by providing members, customers, patients and providers with accurate, consistent, timely and meaningful information. They will provide support to member's inquiries and issues as they utilize the KP plan and provider services, continuing to build rapport and collaborative relationships with current and prospective members in accordance with compliance guidelines.

    Essential Responsibilities:

    Available to handle member inquiries regarding:

  • Member Core: Facility Inquiry, Web Support, Promote KP. Org, Order ID Card, Complaint, ID Card Inquiry, Service Review.

  • Member Advance: Eligibility Inquiry, Benefit Inquiry, General, Complaint, Correspondence Inquiry, Add/Remove Dependent, Service Review, New Member Experience, Internal Regional Request, IVR Defaults.

  • Medicare (For up to two (2) regions)

  • Premium Billing Enterprise: Billing Inquiry, Make Payment, Complaint, EFT Inquiry, General, Reinstatement Request, Service Review.

  • KPC Billing, 1095 Tax Form, SLP* (escalations to Tier 3).

  • Represents Health Plan by answering and documenting all incoming contacts to determine their nature and to respond to complex calls related to specialized product lines or queues.

  • Responds professionally to inquiries from internal/external customers. Promotes, ensures and provides customer service to internal/external customers by demonstrating skills which are consistent with the organization's philosophy of providing extraordinary customer relations and quality service.

  • Initiates contact with the appropriate Health Plan, medical group and facility personnel to obtain information relevant to the concern or inquiry as needed.

  • Evaluates data to determine and implement the appropriate course of action to resolve the complaint and/or coordinate service recovery.

  • Documents conversations with members according to procedure.

  • Follows established procedures to meet customer/member needs.

  • Required to effectively interact with diverse work units and relevant organizational departments.

  • Has substantial understanding of the assigned skills and applies knowledge and skills to complete a wide range of tasks.

  • Ability to understand relevant policies, processes and customers.

  • Assist the department in meeting customer needs and reaching department expectations.

  • Completes required training and understand how to use tools available to recall necessary information.

  • Develop a full awareness of the way performance and actions affect members and Member Service.

  • Contact Center's (MSCC) performance guarantees (call handling, first call resolution, complaint resolution compliance, member retention, and return contact as warranted).

  • Consistently supports compliance and the Principles of Responsibility (Kaiser Permanente's Code of Conduct) by maintains the privacy and confidentiality of information, and protects the assets of the organization.

  • Performs other relevant duties as required.

    Basic Qualifications:


  • Minimum two (2) years of customer service experience or KP member-interacting experience required.

  • Education

  • High School Diploma or General Education Development (GED) required.

  • License, Certification, Registration

  • N/A

  • Additional Requirements:

  • Excellent written and verbal communication skills.

  • Demonstrated analytical and problem-solving skills.

  • Working knowledge of systems used within the MSCC.

  • Ability to read and respond briefly, clearly and effectively.

  • Ability to think critically and problem solve.

  • Required Testing:

  • Contact Center Simulation - Must obtain a Recommend rating

  • Typing test - 30 wpm with 5% or less error rate

  • Writing test - must obtain an overall score of 30

  • Math test - must obtain an overall score of 30

  • Must successfully pass knowledge checks while in training.

  • Preferred Qualifications:

  • Call center experience preferred.

  • Health insurance experience preferred.

PrimaryLocation : Colorado,Denver,Lowry Administration 7901 E. Lowry Blvd. Ste 150
HoursPerWeek : 40
Shift : Day
Workdays : Mon - Fri
WorkingHoursStart : Varies
WorkingHoursEnd : Varies
Job Schedule : Full-time
Job Type : Standard
Employee Status : Regular
Employee Group/Union Affiliation : SEIU - Local 105
Job Level : Entry Level
Job Category : Customer Services
Department : MSCC
Travel : No
Kaiser Permanente is an equal opportunity employer committed to a diverse and inclusive workforce. Applicants will receive consideration for employment without regard to race, color, religion, sex (including pregnancy), age, sexual orientation, national origin, marital status, parental status, ancestry, disability, gender identity, veteran status, genetic information, other distinguishing characteristics of diversity and inclusion, or any other protected status.

External hires must pass a background check/drug screen. Qualified applicants with arrest and/or conviction records will be considered for employment in a manner consistent with federal and state laws, as well as applicable local ordinances, including but not limited to the San Francisco and Los Angeles Fair Chance Ordinances.
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