Customer Service Representative - Remote Eligible

Customer Service Representative

We are looking for a dedicated and empathetic Customer Service Representative with expertise in healthcare call center operations. In this role, you will handle inquiries related to medical eligibility, benefits, claims, and provider information while maintaining a high level of professionalism and accuracy. This is a contract to permanent position that offers the opportunity to grow within the organization for the right candidate. While the position is primarily remote, occasional in-office attendance may be required depending on location.

Responsibilities:

• Respond to a high volume of customer inquiries via phone and email regarding medical benefits, claims, and provider information.
• Provide accurate and detailed information about healthcare plans, pre-authorizations, and claim statuses.
• Utilize tracking systems to document all interactions and ensure proper follow-up.
• Stay updated on changes to healthcare policies, procedures, and benefits to provide accurate guidance.
• Resolve customer complaints and troubleshoot issues with professionalism and efficiency.
• Advise members on outstanding payments and explain billing details when necessary.
• Assist callers in navigating network provider options and understanding plan coverage.
• Escalate complex issues to supervisors or managers when required.
• Collaborate with team members to ensure seamless customer support.
• Adhere to HIPAA policies and maintain confidentiality in all interactions.

Requirements:

• Proven experience in a high-volume call center, ideally within the healthcare industry.
• Familiarity with medical terminology, diagnosis codes, and healthcare processes.
• Strong computer skills, including proficiency in Microsoft Outlook and data entry systems.
• Exceptional verbal and written communication skills with attention to detail.
• Ability to manage stressful situations and calmly assist anxious or upset customers.
• Availability to work flexible hours, including evenings, weekends, or holidays when needed.
• Associate's Degree preferred, or 1-3 years of healthcare customer service experience in a call center setting.
• Commitment to maintaining excellent attendance records and meeting performance targets.