Customer Service Representative

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

📋 Description

• Handle incoming calls from members and providers concerning health plan benefits, claims, eligibility, and general inquiries.

• Investigate, find, and deliver accurate information while ensuring a positive experience for customers.

• Address member service issues by identifying concerns, researching solutions, implementing suitable resolutions, and escalating complex matters when necessary.

• Review and assess claims based on diagnosis codes, procedures, provider details, medical policies, contracts, and established protocols.

• Provide education to members and providers regarding benefits, coverage, and health plan processes.

• Identify members who could benefit from care management or managed care interventions and work alongside clinical staff to facilitate appropriate services.

• Accurately document all interactions in compliance with company policies and regulatory requirements.

• Uphold compliance with HIPAA and all relevant healthcare regulations.

• Achieve productivity, quality, attendance, and customer satisfaction benchmarks.

⛳️ Requirements

• High School Diploma or GED is required.

• Preferred minimum of one (1) year of experience in customer service or a call center environment.

• Experience in healthcare, insurance, Medicare, or Medicaid is preferred.

• Strong proficiency in computer and data entry skills.

• Familiarity with Medicare and Medicaid programs is preferred.

• Exceptional verbal and written communication skills.

• Strong problem-solving and critical-thinking capabilities.

• Ability to multitask and manage multiple systems concurrently.

• Attention to detail and a commitment to accuracy.

• Ability to work both independently and collaboratively as part of a team.

• Maintain a professional demeanor with a strong emphasis on customer satisfaction.

• Ensure compliance with HIPAA and all relevant healthcare regulations.

• Meet productivity, quality, attendance, and customer satisfaction standards.

🏝️ Benefits

• Opportunities for career advancement within the organization.

• A fulfilling work environment.

• Chance to contribute to providing exceptional service to both internal and external customers.