Medical Customer Service Agent

Job Summary

As a full-time hybrid Medical Customer Service Agent, the incumbent will manage communication inquiries and complaints from stakeholders, ensuring timely responses and high standards of customer service while documenting case details for follow-up actions.

Key responsibilities:

• Handle claims pre-certification and adjudication while providing guidance on medical case reviews and authorizations over the phone
• Respond to queries regarding coverage, claims, hospitalization, and complaints through various communication channels
• Commit to departmental service standards and utilize AI insights to enhance team performance and customer satisfaction

Required qualifications:

• Medical background (Veterinary Medicine, Pharmacy, Science, etc.) is essential
• 6 months to 3 years of experience in a customer-facing role, preferably in a call center environment
• Insurance experience is a plus
• Strong knowledge of Microsoft Office (Excel, Word)
• Flexibility to work rotating shift patterns, including nights and weekends