Commercial Health Customer Service Representative

Job Summary

To provide empathetic health insurance support, the full-time Commercial Health Customer Service Representative will manage inbound and outbound calls and email inquiries remotely, delivering accurate information on health plan benefits, eligibility, claims, and billing while ensuring a positive experience for members and providers.

Key responsibilities

• Researches and resolves member and provider inquiries, meeting department metrics and turnaround times
• Explains plan benefits, eligibility, and claims processes while providing support for providers on claim status and prior authorization
• Collaborates with internal teams to document interactions and 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; Microsoft 365 proficiency required