Customer Service Representative

The Customer Service Representative corresponds with callers providing benefit information, claim status, or general health plan information based on the schedule of benefits stated in the plan documents by performing the following duties. Training is conducted remotely and upon successful completion will work remotely. The schedule varies based on business needs but can be performed between the hours of 8:00 am to 8 pm Monday – Friday, Eastern Time zone.

Primary Responsibilities:

• Create a welcoming experience by authentically engaging every caller, every time.
• Make a connection with customers by engaging in friendly and genuine conversation throughout each call to provide a world-class experience.
• Interacting with team and co-workers in a supportive and purpose-drive environment.
• Thoroughly and accurately answer questions about customers’ healthcare accounts.
• Thoughtfully listen to callers’ needs and provide appropriate solutions.
• Demonstrate a culture of ethical conduct, safety, and compliance.
• Handle 35-50+ inbound and outbound phone calls per day.
• Work closely with claim staff to make warranted adjustments to claims.
• Other duties are based on business needs.

Qualifications:

• 2+ years of customer service experience; 1+ years in a TPA or payer setting.
• Experience with self-funded plans preferred.
• Bachelor’s degree or medical billing/coding certification.
• Additional TPA or payer experience.
• Strong communication, multitasking, and computer skills (Microsoft Office).
• Ability to work remotely and handle prolonged computer-based tasks.