This is a fully remote position, open to applicants in United States.

• Conduct research, review, and address both inbound and outbound inquiries from members and providers.

• Resolve issues during the first contact whenever feasible, while adhering to turnaround times and departmental metrics.

• Interpret and clarify plan benefits, eligibility, cost-sharing, and decisions related to claims payments.

• Offer support to providers concerning claim statuses, prior authorization requirements, and payment details.

• Assist with inquiries from pharmacy and wellness vendors.

• Manage the initial intake and documentation of elevated member and provider situations.

• Collaborate with Claims, Medical Management, and other internal teams to address complex issues.

• Ensure accurate documentation of every interaction within the designated CRM system.

• Analyze call and inquiry patterns to identify trends for leadership review.

• Guide members in navigating the portal and encourage digital self-sufficiency.

• High school diploma or equivalent is mandatory.

• Minimum of 2 years of customer service experience in supporting commercial fully insured health plan operations.

• Familiarity with commercial health plan benefits, eligibility, and claims processes is essential.

• Proven knowledge of CPT, ICD-10, HCPCS, and Revenue Codes.

• Proficiency in Microsoft 365 is required.

• Eligible candidates must reside in or work from the United States within either the CST or EST time zone.

• A dedicated workspace that is separate from personal living areas, ensuring information privacy.

• Capability to keep all company-sensitive documents secure.

• Must have access to a location with high-speed internet service already established.

• Competitive salary.

• Comprehensive health, dental, and vision insurance, along with life and disability coverage.

• Retirement savings plan with a company match.

• Generous time off and vacation policy.

• Opportunities for professional development.

• Flexible working conditions in a remote environment.