Customer Service Representative

Customer Service Representative CSR Reporting to the Independent Dispute Resolution Entity (IDRE) Stakeholder Engagement Subject Matter Expert, the Customer Service Representative (CSR) shall be in contact with Initiating Party and Non-initiating party stakeholders. The CSR shall be primarily responsible for efficiently answering inquiries telephonically and via email. The CSR shall record requests, collaborate with team members regarding inquiries, triage urgent requests or concerns and provide follow-up of inquiries to ensure stakeholders concerns are efficiently and effectively prioritized. The IDRE CSR is responsible for escalating matters to the IDRE Stakeholder Engagement SME. The IDRE SCR documents inquiries and provides reporting to trend inquiries. Outcomes of documentation may be used for continuous quality improvement initiatives.ResponsibilitiesUnderstand and represent PRI mission, vision, and values to all internal and external customersInteract with government and private sector clients, partners, and PRI staff in a professional and accountable manner, and as a representative of PRI managementInteract with project team members in order to successfully fulfill contract obligations with the highest quality and in a timely manner meeting PRI ISO requirementsInstills integrity throughout the organization via active participation in ISO requirements including but not limited to timely submission of Corrective Action Plans for all matters in which either PRI standards and/or corporate contract standards have not been met. Communicates outcomes to team members to ensure a positive, open, environment which mitigates risk and achieves a culture of Continuous Quality ImprovementEngage clients in appropriate communication that manages client expectations and builds a collaborative relationship with the clientRespond to telephone inquiries promptly, professionally, and efficiently to provide first call resolutionUnderstand and resolve customer requests, questions and provide analysis of situations to determine best use of resourcesObtain, evaluate and analyze all relevant information to successfully handle inquiresServes as liaison between the customer and various departments or team members in response to inquiresDirect unresolved issues to designated departments or team members for further investigation if necessaryParticipation in educating and communicating the program requirements to stakeholdersRespond to all written inquires (letter, fax, and email) in a professional mannerKeep records of stakeholder interactions and transactionsRecord details of actions taken and provide follow-up and results orientation based upon established protocolsIdentification of analysis of trends and reporting to management teamMaintain a communications log that documents all inquiries, including telephonic, written, and e-mailActively participates in quality assurance activities; identifies trends and reports to management teamRecommend process improvement to management team (Lessons learned & Best Practices)Maintain a high level of knowledge and comply with all protocols, policies and proceduresFile all project documents (hard and soft copies)Provide assistance as needed to team membersPerform other duties as assignedRequirements:Associates Degree with a minimum of two (2) years general related experience in lieu of a degree, 2 additional years of related experience is required.Ability to work in a high volume and high pressured call centerFamiliarity with Current Procedural Terminology (CPT) codes, International Classification of Diseases, Ninth Revision, Clinical Modification (ICD-9-CM) codes, and Healthcare Common Procedural Coding System (HCPCS) codesCandidates having experience with IDR, No Surprises Act or experience working in a customer service capacity with a health insurance company are preferred.Excellent communication skills, both verbal and written. Ability to speak clearly in a professional manner so the stakeholder can understand and comprehend the interview/survey questionsPossesses high level of time management and organizational skillsMust have excellent customer service, interpersonal, listening, and problem-solving skillsConsistently handles inquiries in the friendly and professional mannerReliable, honest, and trustworthy; Integrity is requiredDemonstrated ability to work with others in a team environmentExcellent data entry skills with high level of accuracy; able to work under production guidelinesMust be proficient in Microsoft Applications such as MS Word, Excel, and AccessDemonstration of adherence to deadlinesFlexibility to changing requirements and contingenciesWilling to take on additional tasks as required and learn new skillsWillingness and ability to undertake training needed in order to fulfill the changing requirements of the jobAbility to interface with all levels of management and staff personnelMust have no conflict of interest (COI) as defined in 1154(b)(1) of the Social Security Act (SSA)Ability to obtain and maintain U.S. Government Security ClearancePreference will be given to individuals who reside in, or are willing to relocate to, a recognized HUBZone area. (Go to for more information).FLSA status: Non-exemptThe PRI Team Member Compensation Plan is applicable to this positionPRI is an equal employment opportunity employer. All qualified applicants including Disability/Vets or other qualified applicants will receive consideration for employment without regard to race, color, religion, gender, national origin, disability status, protected veteran status or any other characteristic protected by law.

Created: 2025-05-11