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Customer Service Representative in Scarborough, ME at KEPRO

Date Posted: 1/20/2018

Job Snapshot

Job Description




JOB TITLE:            Customer Service Representative

REPORTS TO:      Supervisor, Customer Service

FLSA STATUS:     Non-Exempt

Summary Description

Responsible for supporting the prior authorization process by answering incoming telephone calls, resolving customer questions, complaints and requests adhering to internal policies and procedures and utilizing working knowledge of the organization’s services to meet productivity and quality standards.  


  • Develops and maintains working knowledge of internal policies, procedures and services (both departmental and operational). 
  • Utilizes automated systems to log and retrieve information. Performs accurate and timely data entry of electronic faxes.
  • Receives inquiries from customers or providers by telephone, email, fax, or mail and communicates response within required turnaround times. 
  • Responds to telephone inquiries and complaints in a prompt, accurate, and courteous manner following standard operating procedures.
  • Interacts with external providers. 
  • Investigates and resolves or reports customer problems. Identifies and escalates difficult situations to the appropriate party.
  • Meets or exceeds standards for call volume and service level per department guidelines. 
  • Initiates files by collecting and entering demographic, provider and procedure information into the system. 
  • Serves as liaison between the Review Supervisors and external providers.
  • Maintains logs and documents disposition of incoming and outgoing calls.

The list of accountabilities is not intended to be all-inclusive and may be expanded to include other duties that management may deem necessary from time to time.


  • High School diploma or equivalent.
  • Medical terminology course(s) helpful.

Knowledge, Skills & Abilities

Knowledge of:

  • Medical terminology
  • Health insurance industry

Ability to:

  • Speak English fluently enough to be clearly understood over the telephone.
  • Use phone system effectively.
  • Research and investigate.
  • Follow confidentiality policies and procedures.
  • Navigate and use electronic equipment and systems easily and proficiently.
  • Multitask on a personal computer while conducting telephone conversations.
  • Work in a fast-paced call center environment
  • Remain calm and courteous when handling difficult calls and request


  • Bilingual Spanish-English a plus.
  • Effective verbal and listening skills to provide courteous and professional customer service.
  • Effective PC skills including, electronic mail, intranet and industry standard applications.


  • 2+ year’s customer service/telephone experience in a similar call center environment and/or industry.

Mental and Physical Requirements

The physical demands described here are representative of those that must be met by an employee to successfully perform the essential functions of this job.  Reasonable accommodations will be made as required by law in an attempt to enable an individual with a disability to perform the essential functions of this job.  While performing the duties of this job, the employee must have the ability to read and interpret data and complex information and function in a team environment.  In addition, the employee is required to sit for extended periods of time; key and/or control objects; occasionally lift and/or move objects weighing up to 15 pounds; use a personal computer and communicate effectively with internal and external customers.



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