About the Role

Join our team as a Customer Care Representative specializing in our Healthcare Account. In this vital role, you will be the primary point of contact for patients, healthcare providers, and/or plan members, providing exceptional service and support regarding medical benefits, claims, prescriptions, appointments, or general health inquiries. You must handle sensitive information with discretion and empathy, ensuring compliance with all privacy regulations (e.g., HIPAA).

Key Responsibilities

• Handle Inbound/Outbound Communication: Professionally manage a high volume of calls, emails, and/or chat interactions from customers, addressing inquiries related to:
• Insurance eligibility and benefits verification.
• Medical claims status and resolution.
• Authorizations and referrals.
• Prescription information and fulfillment.
• Locating in-network providers or scheduling appointments.
• Problem Resolution: Investigate and resolve complex customer issues, navigating internal systems and collaborating with clinical or billing departments when necessary.
• Documentation & Compliance: Accurately document all customer interactions and transactions in the CRM system while strictly adhering to company policies, procedures, and healthcare privacy regulations (e.g., HIPAA).
• Education & Guidance: Clearly and compassionately educate customers on their healthcare plans, services, and options, helping them understand complex medical terminology and processes.
• Quality Assurance: Meet or exceed established performance metrics for customer satisfaction, call quality, efficiency, and accuracy.

Qualifications & Skills