Commercial Health Call Center Rep

Job Summary

Providing essential support to members and providers, the full-time remote Commercial Health Call Center Representative will manage inbound and outbound inquiries, delivering accurate information on health plan benefits, eligibility, claims, and billing while ensuring a compassionate customer experience.

Key responsibilities

• Research and resolve member and provider inquiries, aiming for first-contact resolution while meeting departmental metrics
• Accurately explain plan benefits, eligibility, and claims decisions, utilizing knowledge of relevant coding systems
• Document escalated situations and collaborate with internal teams to address complex issues effectively

Required qualifications

• High school diploma or equivalent required
• 2+ years of customer service experience supporting commercial fully insured health plan business
• Working knowledge of commercial health plan benefits, eligibility, and claims processes
• Demonstrated knowledge of CPT, ICD-10, HCPCS, and Revenue Codes; proficiency in Microsoft 365 required