Customer Service Representative

Job Summary

Handling routine member and provider inquiries, the full-time Customer Service Representative will assist with benefits, claims, and eligibility questions while working remotely to ensure a positive customer experience.

Key responsibilities

• Answer inbound calls and provide accurate information regarding health plan benefits and claims
• Resolve member service issues by researching solutions and escalating complex cases as necessary
• Educate members and providers on health plan processes and collaborate with clinical staff for care management interventions

Required qualifications

• High School Diploma or GED required
• Minimum of one (1) year of customer service or call center experience preferred
• Working knowledge of Medicare and Medicaid programs preferred
• Previous experience in healthcare or insurance preferred
• Strong computer and data entry skills