Customer Service Representative

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

📋 Description

• Handle a large volume of incoming calls from medical provider offices, members, group administrators, and other stakeholders.

• Communicate and collaborate efficiently with Group Administration, Individual Administration, Electronic Eligibility, and Client Services.

• Attentively listen to caller inquiries and concerns, providing accurate and timely responses.

• Achieve call audit standards and operational expectations, including availability, call quality, average call handle time, and other individual and departmental metrics.

• Document and keep precise, clear call records for internal staff reference.

• Appropriately escalate calls following internal guidelines and procedures.

• Investigate claim-related issues to deliver accurate and informed responses.

• Ensure compliance with Federal, State, and HIPAA regulations and guidelines.

⛳️ Requirements

• Experience in Inbound or Outbound Customer Service or Financial Services within health plans or healthcare.

• Exceptional oral and written communication abilities.

• Proficient in MS Office applications (Word, Excel, Outlook).

• Strong listening and problem-solving skills with a patient, customer-oriented approach.

• Capability to multitask in a dynamic, metrics-driven environment.

• Experience with Member or Provider phone interactions (preferred).

• Familiarity with Medicaid or Medicare (preferred).

• Prior experience in medical claims, either processing or Customer Service Representative (preferred).

• Understanding of HIPAA and CMS Guidelines (preferred).

• Call Center experience, whether inbound or outbound (preferred).

🏝️ Benefits

• Competitive salary and performance-based incentives.

• Comprehensive health, dental, and vision insurance.

• 401(k) plan with company match.

• Opportunities for professional development and career advancement.

• Flexible work schedules and remote work options.