Customer Service Specialist

Job Summary

A company is looking for a Customer Service Specialist to support customer inquiries and enhance service delivery.

Key Responsibilities

• Address complex customer inquiries through various communication channels while ensuring confidentiality and professionalism
• Champion customer-centricity by actively listening to member concerns and advocating for solutions
• Support health management functions by collecting participant information, scheduling appointments, and conducting outbound calls

Required Qualifications

• High School diploma or GED with five to seven years of experience in a healthcare customer service call center
• Strong knowledge of health claims processing and understanding of benefit contracts and policies
• Ability to interpret Plan Documents and understand regulatory requirements such as ACA, HIPAA, ERISA, and COBRA
• Fluent in English; bilingual in Spanish preferred
• Proficient in learning new software and navigating multiple systems simultaneously