Health Insurance Call Center Representative (Medicare)

About the role

Insurance Administrative Solutions (IAS) is a third-party provider of comprehensive administrative solutions for clients in the insurance industry, offering business process outsourcing that helps insurers optimize administrative workload, bolster industry expertise, leverage emerging technologies, and streamline operations. IAS delivers value through compassionate customer service, efficient processing, and quality results within a highly collaborative team environment where all employees have valuable input.

Job Summary: Receive, organize, and make daily use of information regarding benefits, contract coverage, and policy decisions to provide prompt, courteous customer service that meets or exceeds service standards. Interpret contract benefits in accordance with specific claims processing guidelines.

Responsibilities

• Interpret contract benefits accurately to policyholders, agents, and providers
• Provide claim status to policyholders or providers
• Send out refund request letters and follow up as necessary
• Produce correspondence to customers
• Answer calls as required by company policy in a helpful, professional, timely manner
• Place outgoing calls as needed to provide or obtain information
• Document (written/on-line) all calls while in progress
• Transfer calls to employees in other departments as required to meet customer needs
• Fully document policy file or imaging system with all related material to leave a clear and concise audit trail
• Actively participate in cross training and group training sessions to maximize team efficiency and maintain or exceed service standards
• Communicate problems identified relevant to the claims processing system to the appropriate people
• Maintain external contacts with policyholders, providers of service, agents, attorneys, and other carriers as well as internal contacts with peers, management, and other support areas with a positive and professional approach
• Communicate openly with Supervisor, Team Lead, and other team members to ensure accurate responses and avoid duplication of efforts

Requirements

• High school diploma or GED equivalent
• Insurance background preferred
• 0–2 years of proven customer support experience; prior call center experience preferred
• Strong phone contact handling skills and active listening
• Familiarity with Microsoft Office products
• Ability to adapt and respond to different types of people and tasks
• Excellent communication and documentation skills
• Ability to multi-task, prioritize, and manage time effectively and efficiently
• Reliable transportation and the ability to be punctual and dependable
• May have agent license but no active appointments