Customer Service Representative
Position Based online, the software arm of Stark Drive is a major engineering and Manufacturing group with a reputation for building affordable transportation solutions for our clients. Due to a major expansion we have immediate need for a hands-on and talented Customer Service Representative to join our team.
To increase member satisfaction, retention, and growth by efficiently delivering competitive services to members and providers through a fully-integrated organization staffed by knowledgeable, customer-focused professionals supported by exemplary technologies and processes.
Answers questions and resolves issues based on phone calls/letters from members, providers, and plan sponsors. Triages resulting rework to appropriate staff. Documents and tracks contacts with members, providers and plan sponsors. (*)
Explains member's rights and responsibilities in accordance with contract. (*)
Processes claim referrals, new claim handoffs, nurse reviews, complaints (member/provider), grievance and appeals (member/provider) via target system. (*)
Educates providers on our self-service options; Assists providers with credentialing and re-credentialing issues. (*)
Responds to requests received from Aetna's Law Document Center regarding litigation; lawsuits. (*)
Handles extensive file review requests. Assists in preparation of complaint trend reports. Assists in compiling claim data for customer audits. (*)
Determines medical necessity, applicable coverage provisions and verifies member plan eligibility relating to incoming correspondence and internal referrals. (*)
Handles incoming requests for appeals and pre-authorizations not handled by Clinical Claim Management .(*)
Performs review of member claim history to ensure accurate tracking of benefit maximums and/or coinsurance/deductible. Performs financial data maintenance as necessary. (*)
Uses applicable system tools and resources to produce quality letters and spreadsheets in response to inquiries received. (*)
Experience in a production environment.
Customer Service experiences in a transaction based environment such as a call center or retail location preferred.
The highest level of education desired for candidates in this position is a High School diploma, or equivalent experience.
Functional - Customer Service/Customer Service - Member Services - Traditional products/1-3 Years
Functional - Customer Service/Call center monitoring & analysis - Inbound calls - call center location/1-3 Years
Technical_Experience/Technical_Focus/1-3 Years/End User
Service/Demonstrating Service Discipline/FOUNDATION
Service/Handling Service Challenges/ADVANCED
Service/Providing Solutions to Constituent Needs/FOUNDATION
Service/Creating a Differentiated Service Experience/ADVANCED
Salary and Benefits
Stark Drive LLC offers competitive salaries based on candidate's qualifications. Stark Drive LLC also offers five weeks paid vacation per year, eleven paid holidays per year, retirement plan with employee matching funds and an overall comprehensive benefits package.
Stark Drive LLC is an equal opportunity employer and all qualified applicants will receive consideration for employment without regard to race, color, religion, sex, national origin, disability status, protected veteran status, or any other characteristic protected by law.
About Stark Drive
Stark Drive LLC is a developer and manufacturer of electric based transportation solutions. We are a company that provides innovative solutions to end users, companies and governments to help move people around. Founded in 2016 with offices in the USA, Prototyping facilities in Europe as well as Manufacturing facilities in China, Stark Drive and its employees work from global offices providing deep technical expertise and regional knowledge to improve customer engagement, boost operational efficiency, reduce costs and achieve superior business results.
Every day, Stark Drive employees partner with customers to reimagine the world we live in and create a more sustainable world tomorrow.