As a Healthcare Customer Service Representative, you will be the first point of contact for our members, providers, and other stakeholders, providing professional and empathetic support on a wide range of inquiries. Your key responsibilities will include:

• Become a Benefits Expert: Clearly and accurately explain complex health insurance benefits, eligibility, and plan options (including medical, dental, vision, and pharmacy) to help members maximize their coverage.
• Resolve Complex Inquiries: Own and resolve issues related to claims, billing, prior authorizations, and referrals with efficiency and a focus on first-call resolution.
• Patient Advocacy: Act as a compassionate guide for patients, especially during times of stress, ensuring they receive the information and resources needed for quality care.
• Accurate Documentation: Maintain meticulous records of all customer interactions and transactions in our systems (CRM/EHR), ensuring compliance with strict privacy regulations (like HIPAA).
• Collaborative Problem-Solving: Partner with internal teams (e.g., Clinical, Billing, Enrollment) to escalate and resolve complex cases, always following up to ensure a complete resolution.
• Uphold Excellence: Consistently meet or exceed key performance indicators (KPIs) for quality, productivity, and customer satisfaction.

What You Bring: Skills for Success

• Empathy and Patience: A genuine desire to help others and the ability to remain calm, professional, and composed while handling sensitive or escalated calls.
• Exceptional Communication: Superb verbal and written communication skills with the ability to translate technical or medical jargon into clear, everyday language.
• Problem-Solving Power: Strong analytical and critical thinking skills to quickly assess a situation, research solutions, and provide accurate answers.
• Attention to Detail: Meticulous accuracy in data entry and documentation, especially when handling confidential patient and financial information.
• Adaptability: The ability to learn quickly and navigate various software systems (EHR/CRM) and stay current with evolving healthcare regulations and plan changes.
• Experience: 1+ years of experience in customer service, preferably in a call center, healthcare, or insurance setting (knowledge of medical terminology is a plus!).