Customer Service Representative I

About the role

MagnaCare is seeking detail-oriented and empathetic Las Vegas-based Customer Service Representatives to provide telephonic support to members, physicians, hospitals, revenue agencies, and other healthcare providers with member benefits, eligibility, claims inquiry, claim reconsiderations, and appeals.

Responsibilities

• Handle frontline Culinary, Hospitality, and/or Alaska volumes.
• Provide timely and professional support to members and providers regarding benefits, eligibility, claims, and appeals via phone, email, and chat.
• Handle escalated customer concerns and complaints.
• Assist with claims processing.
• Collaborate with the Benefits Enrollment team to resolve eligibility, hours, and co-premium inquiries, proactively following up with members as needed.
• Actively listen to customer concerns, demonstrating empathy and offering effective solutions.
• Analyze and resolve non-standard and complex issues using critical thinking and problem-solving skills.
• Maintain a strong understanding of client products, services, and policies to provide accurate and informed assistance.
• Document all interactions and resolutions accurately in the system to ensure seamless customer service.
• Adhere to regulatory requirements, company policies, and confidentiality guidelines when handling member information.

Requirements

• Prior customer service experience serving unions preferred.
• Prior customer service experience in a high-volume call center, preferably in healthcare, insurance, or a related field is required.
• Experience with claims inquiry and claims review procedures, knowledge of medical specialties, fee schedules, complaints and appeals, and call center responsibilities required.
• Strong communication skills with the ability to explain complex information in a clear and empathetic manner.
• Ability to manage multiple inquiries while maintaining attention to detail and accuracy.
• Problem-solving skills and the ability to navigate complex eligibility and claims issues.
• Effective communication through various channels, including email, chat, and voice.
• Salesforce experience preferred.
• Bilingual preferred.
• Intermediate proficiency in Microsoft Office (Word, Excel, Outlook).