Customer Service Representative, Sr.
About The Role
The Senior Customer Service Representative plays a vital role in delivering compassionate and exceptional customer service to our consumers. This full-time, remote position involves managing inbound calls from providers and members, addressing inquiries related to claim status, review status, and appeals. The role requires a high level of independence, problem-solving skills, and adherence to company policies and compliance standards. The successful candidate will navigate multiple systems to troubleshoot issues, analyze case statuses, and determine appropriate next steps in the claim process. This position offers a dynamic environment where teamwork, empathy, and effective communication are essential. Employees will receive comprehensive training and ongoing support to succeed in their responsibilities, contributing to our mission of improving healthcare outcomes through excellent service delivery.
Qualifications
- A High School Diploma or GED
- Must be 18 years of age or older
- Minimum of 2 years of experience in healthcare, claims, or insurance industries
- At least 2 years of telephonic customer service experience handling high-volume inbound/outbound calls
- Proficiency in Microsoft Word, Outlook, and Excel
- Ability to work an 8-hour shift between Monday and Friday, 07:00 AM - 07:00 PM CST (shift to be assigned after training)
- Strong communication and problem-solving skills
Responsibilities
- Handle inbound calls from providers and members via the Provider Inquiry Line, addressing questions related to claim, review, and appeal statuses
- Review case statuses, research claims platforms, and medical record repositories to analyze case lifecycle and determine next steps
- Navigate multiple computer applications simultaneously to troubleshoot and resolve inquiries efficiently
- Document all interactions accurately and thoroughly within relevant systems
- Maintain adherence to productivity standards of 95% or higher
- Ensure compliance with all federal, state, and company policies, including reimbursement and contract adherence
- Work independently while also collaborating effectively within a team environment
- Act as a resource for colleagues and contribute to team knowledge sharing
- Demonstrate empathy, patience, and active listening to support internal and external customers
- Adapt to changes in schedules, processes, and technology within a call center environment
- Perform additional duties as assigned to support departmental goals and initiatives
Benefits
- Comprehensive health, dental, and vision insurance plans
- Paid training programs to support skill development
- Incentive and recognition programs to reward performance
- Opportunities for career growth and advancement within the organization
- 401(k) retirement plan with company contributions
- Equity stock purchase options
- Flexible remote work environment with necessary tools and support
- Paid time off and holidays