Customer Care Specialist- (Hybrid-Must be base in or near Orlando FL)

Responsibilities

• Engage inbound callers professionally; actively listen and probe to determine the purpose of the call and resolve administrative concerns, including claims and dissatisfaction.
• Make outbound calls to solve member issues (e.g., billing issues with a Pharmacy) or additional information needed for a prior authorization.
• Research and communicate member information such as eligibility, benefits, Employee Assistance Program (EAP) services, claims, and authorizations while maintaining confidentiality.
• Initiate care programs by accurately assembling and entering patient data into appropriate systems for EAP, Care, and Utilization Management.
• Educate providers and members on claims submission, treatment plans, appeal processes, and reimbursement rates across multiple networks.
• Identify and respond to crisis calls, assisting clinicians until resolution; make routine referrals and triage decisions not requiring clinical judgment.
• Support continuous improvement by identifying operational inefficiencies, performing follow-up tasks, and ensuring member/provider needs are fully met.
• Document interactions thoroughly; forward necessary information to appropriate staff and refer provider-related inquiries to the correct teams.
• Other duties as assigned.

Requirements

• High school diploma from an accredited school or GED.
• This position is a HYBRID position and will require employee to be ONSITE as needed.
• Must be eligible to work in the United States without the need for work visa or residency sponsorship.
• Must be flexible in scheduling and comfortable with change.
• Must be a proficient typist (avg. 35+ WPM) with strong written and verbal communication skills.
• Demonstrated ability to multi-task and maneuver through various computer platforms while verifying information on all calls.
• Able to thrive in high-volume call center environments, managing a large number of inbound and outbound calls efficiently.
• Familiarity with medical terminology, healthcare procedures, and insurance-related language to effectively support member and provider inquiries.
• Knowledge of HIPAA regulations and other healthcare compliance standards.

Qualifications

• High school diploma from an accredited school or GED.
• This position is a HYBRID position and will require employee to be ONSITE as needed.
• Must be eligible to work in the United States without the need for work visa or residency sponsorship.
• Must be flexible in scheduling and comfortable with change.
• Must be a proficient typist (avg. 35+ WPM) with strong written and verbal communication skills.
• Demonstrated ability to multi-task and maneuver through various computer platforms while verifying information on all calls.
• Able to thrive in high-volume call center environments, managing a large number of inbound and outbound calls efficiently.
• Familiarity with medical terminology, healthcare procedures, and insurance-related language to effectively support member and provider inquiries.
• Knowledge of HIPAA regulations and other healthcare compliance standards.

Skills

• Proficient in medical terminology and healthcare procedures.
• Strong written and verbal communication skills.
• Ability to handle multiple tasks and operate various computer platforms.
• Experience with Genesys and CRM technology platforms.

Benefits

To review our Benefits, Incentives and Additional Compensation, visit our Benefits Page and click on the "Benefits at a glance" button for more detail here.

Pay

Potential pay for this position ranges from $17.85 - $25.48 based on experience and skills.

Schedule

This position is a HYBRID position and will require employee to be ONSITE as needed.