Claims Customer Service Representative II (Remote)

At AMA Insurance, we offer life, health, and disability insurance to doctors and their families at competitive rates. As part of the American Medical Association (AMA), we are dedicated to improving the health of the nation through our mission to promote the art and science of medicine and the betterment of public health.

About the role

We are seeking a Claims Customer Service Representative II to join our remote team. This role will handle claim-related inquiries and interactions with insureds and providers, ensuring quality service delivery.

Responsibilities

• Respond to incoming calls related to claim status inquiries within established response times and quality standards.
• Log brief descriptions of calls on CAMS and CAPS systems.
• Make outbound calls to support returned checks and resolve claim inquiries.
• Refer claims to AMAI Claim Supervisor for immediate attention if improperly handled.
• Fulfill claim form requests for plans not administered by AMA Insurance.
• Communicate with insurance carriers or service providers to provide feedback on claims administered by carriers.
• Handle waiver of premium transactions, cancellations due to death, and other claims-related transactions.
• Update contact management and send customer surveys.
• Provide information regarding benefits, eligibility, plan provisions, premium billing, and certificate changes as needed.
• Process changes to Administration System, including personal and coverage information, and send documents to callers when needed.
• Support business operations through participation in special projects as assigned.
• Contribute to process improvements and operational efficiencies by documenting workflows and service processes.
• May include other responsibilities as assigned.

Requirements

• A high school diploma or equivalent education.
• Minimum of 2+ years’ experience in life, health, or Medicare insurance.
• A Health or Life insurance license is preferred.
• Demonstrated experience working in a high-volume customer service call center.
• Excellent telephone skills, including proper telephone technique, multitasking, and ability to control the call.
• In-depth understanding of claim adjudication and benefits.
• Strong experience handling customer issues, including technical and financial related issues.
• Strong knowledge of insurance products, benefits administration, or third-party administration services.
• Health insurance knowledge is preferred.
• Excellent verbal and written communication skills with a high level of professionalism.
• High level proficiency with call center systems, telephony platforms, and personal computers.
• Advanced proficiency in Microsoft Office Suite (Word, Excel, Access, PowerPoint) and database systems.
• Ability to provide technical support for online tools, systems, and customer-facing platforms.
• Strong business process skills, including the ability to document, monitor, and improve workflows.
• Excellent planning, organization, and time management skills with the ability to manage multiple priorities in a fast-paced environment.
• Ability to build and maintain positive relationships with internal and external stakeholders.

Pay

The hourly range for this position is $23.63 - $30.83. This is the lowest to highest rate we believe we would pay for this role at the time of this posting. Employees are also eligible to participate in an incentive plan.

Schedule

This role is remote and can be performed from anywhere in FL, IL, IN, and WI.