Claims Customer Service Representative

Job Summary

Working from home in Pennsylvania, the full-time Claims Customer Service Representative will assist in resolving customer concerns, provide education and instruction, and maintain customer satisfaction while actively participating in cross-training and process improvement within the Customer Service team.

Key responsibilities:

• Resolve enrollment reports and eligibility issues by adhering to policies and state regulations
• Initiate communication with newly enrolled members and interpret rules in contractual agreements
• Review and resolve suspended claims while providing support to member and provider services staff regarding claims issues

Required qualifications:

• High School Diploma or Equivalent (GED) required
• Minimum of 1 year of customer service experience required
• Ability to work in a quiet, dedicated workspace with a high-speed internet connection
• Familiarity with customer support policies and procedures
• Proficiency in generating and disseminating communications related to enrollment activity