Customer Service Representative II

Job Summary

Providing exceptional support to members and customers, the full-time remote Customer Service Representative II will manage complex inquiries related to health plan services, eligibility, billing, and claims, while fostering strong relationships in compliance with organizational guidelines.

Key responsibilities:

• Handle member inquiries regarding eligibility, benefits, billing, and claims, ensuring accurate and timely responses
• Document all interactions and coordinate with appropriate personnel to resolve complex issues and complaints
• Support department goals by adhering to performance metrics and maintaining compliance with privacy and confidentiality standards

Required qualifications:

• Minimum of 2.5 years of customer service experience, including 6 months as a Customer Service Representative I
• High School Diploma or General Education Diploma (GED) required
• Must pass department-administered Tier II Assessment with a minimum score of 70%
• Strong knowledge of systems used within the Member Service Contact Center
• Ability to manage work with minimal direction and demonstrate analytical skills