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About the Role

As a Healthcare Call Center Representative, you will be the cornerstone of our commitment to customer satisfaction. In this role, you will provide comprehensive support and information to members, providers, and patients, ensuring they get the most out of their healthcare plans and services. Your objective is to deliver extraordinary service while building trust and rapport with current and prospective members by adhering to compliance guidelines and embodying company values.

Responsibilities

Manage inquiries in areas such as Member Services, Medicare, and Billing.
Represent our client professionally by addressing and documenting all incoming queries, including complex calls related to specialized product lines.
Uphold the organization’s philosophy of extraordinary customer relations.
Proactively engage with Health Plan, medical group, and facility personnel to gather relevant information for resolving member inquiries.
Analyze and evaluate customer issues to initiate and coordinate service recovery measures.
Document all member interactions meticulously following established procedures.
Demonstrate familiarity with health insurance terminology (copays, deductibles, claims, authorizations, etc.).
Understand Medicare/Medicaid plans and regulations, and explain plan benefits, provider networks, and coverage policies.
Leverage a thorough understanding of company policies and processes to meet customer needs effectively.
Contribute to departmental goals and objectives while maintaining proficiency through ongoing training and use of required tools.
Monitor and achieve Contact Center KPIs, including call handling, first call resolution, and member retention.
Consistently uphold company compliance standards and Code of Conduct, ensuring privacy and confidentiality of member information.
Adhere to HIPAA regulations to protect personal health information (PHI) and maintain data security.
Use multiple systems/screens while assisting callers effectively.
Navigate CRM, EMR/EHR, and ticketing platforms effectively.

Requirements

Minimum of two (2) years of customer service or healthcare member-interaction experience.
Previous call center experience and/or prior experience in the health insurance industry (preferred).
A dedicated, quiet workspace with a door that closes, free from ambient noise.
A comfortable desk and chair setup that allows for the proper installation of necessary equipment.
Stable, high-speed internet with a minimum bandwidth of 20 Mbps downstream and 20 Mbps upstream.
Comfort with technology and ability to learn new systems quickly.
Ability to stay productive and manage your time effectively in a remote environment.
Strong verbal and written communication skills, especially in a virtual setting.
Ability to adapt to changing technologies and procedures while working remotely.

Skills

Outstanding written and verbal communication skills.
Proven analytical and problem-solving abilities.
Ability to respond concisely and clearly to customer queries.
Strong critical thinking and problem-solving skills.
Typing speed of at least 35 WPM with a 5% or lower error rate.

Location

Remote (Virtual Environment)

Work Type

Remote
Full-time

Experience Level

2+ years of customer service or healthcare member-interaction experience

Education Level

High School Diploma or GED required

Salary/Compensations

Competitive hourly rate

Benefits

Full health insurance coverage, including medical, dental, and vision plans.
$25/month per line for unlimited phone, text, and data (restrictions may apply).
Referral for Life Program™: Earn residual bonuses for referring employees who join the team and remain with the company.

About the Company

Trusted Leader in Healthcare Services
Committed to bringing passion and customer focus to the business.
If you like wild growth and working with happy, enthusiastic over-achievers, you'll enjoy your career with us!

Equal Opportunity

We are an Equal Opportunity Employer, welcoming individuals with disabilities and veterans.