Customer Care Center Representative

Job Description

REQUIREMENTS

• High School Diploma or GED or equivalent experience.
• One (1) or more years of customer service experience in a fast paced, high-volume health insurance or healthcare call center environment.
• Strong verbal and written communication skills with the ability to effectively explain complex information.
• Demonstrated problem-solving skills with the ability to handle difficult situations with empathy and patience.
• Solid ability to multitask, prioritize, and manage time effectively in a fast-paced environment.
• Ability to maintain a high level of accuracy and attention to detail.
• Proficiency in Microsoft Office Suite and website and/or portal navigation.
• Ability to adhere to a structured work schedule based around the central time zone.

Preferred

• Familiarity with customer service software such as Facets or NTT.
• Basic knowledge and understanding of medical terminology.

RESPONSIBILITIES

• Serve as the first point of contact for members, brokers, and medical providers, answering inquiries regarding benefits, eligibility, claims, billing, and healthcare services.
• Assist members in understanding their benefits, eligibility, claim status and the resolution of billing issues.
• Respond to provider inquiries related to claims, authorizations, and reimbursement status.
• Address and resolve service requests, complaints and issues efficiently, ensuring high levels of customer satisfaction.
• Collaborate with internal teams to address complex inquiries and facilitate a seamless experience.
• Review detailed information across multiple systems to accurately resolve inquiries while delivering clear, professional, and thorough responses (both written, and verbal), that are easy to understand by a diverse population.
• Accurately document all interactions in the system, ensuring thorough record-keeping for follow-up actions and quality assurance purposes.
• Develop a thorough understanding of health plan products and services, actively learning updates to policies, procedures, and regulatory requirements.
• Ensure adherence to regulatory guidelines (i.e., HIPAA, CMS) when providing information and service to members, providers or brokers.
• Other job-related responsibilities may be assigned as required.

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