Healthcare Call Center Representative

As a Healthcare Call Center Representative, you will be the cornerstone of our commitment to customer satisfaction, providing comprehensive support and information to members, providers, and patients to ensure they get the most out of their healthcare plans and services.

Responsibilities

• Manage inquiries in areas such as Member Services, Benefits, Medicare, and Billing.
• Represent our client professionally by addressing and documenting all incoming queries, including complex calls related to specialized product lines.
• Uphold the organization’s philosophy of extraordinary customer relations.
• Proactively engage with Health Plan, medical group, and facility personnel to gather relevant information for resolving member inquiries.
• Analyze and evaluate customer issues to initiate and coordinate service recovery measures.
• Document all member interactions meticulously following established procedures.
• Demonstrate familiarity with health insurance terminology (copays, deductibles, claims, authorizations, etc.).
• Understand Medicare/Medicaid plans and regulations, and explain plan benefits, provider networks, and coverage policies.
• Leverage a thorough understanding of company policies and processes to meet customer needs effectively.
• Contribute to departmental goals and objectives while maintaining proficiency through ongoing training and use of required tools.
• Monitor and achieve Contact Center KPIs, including call handling, first call resolution, and member retention.
• Consistently uphold company compliance standards and Code of Conduct, ensuring privacy and confidentiality of member information.
• Adhere to HIPAA regulations to protect personal health information (PHI) and maintain data security.
• Use multiple systems/screens while assisting callers efficiently.
• Navigate CRM, EMR/EHR, and ticketing platforms effectively.

Requirements

• Minimum of two (2) years of customer service or healthcare member interaction experience.
• Previous call center experience.
• High School Diploma or GED required.
• Outstanding written and verbal communication skills.
• Proven analytical and problem-solving abilities.
• Ability to respond concisely and clearly to customer queries.
• Strong critical thinking and problem-solving skills.
• Typing speed of at least 35 WPM with a 5% or lower error rate.
• Ability to navigate and manage multiple systems simultaneously.
• Attendance is critical—100% participation during the first 90 days of training is required.

Remote Work Requirements

• Private Workspace: A dedicated, quiet workspace with a door that closes, free from ambient noise.
• Ergonomics: A comfortable desk and chair setup that allows for the proper installation of necessary equipment.
• Reliable Internet Connection: Stable, high-speed internet with a minimum bandwidth of 20 Mbps downstream and 20 Mbps upstream.
• Quiet, Distraction-Free Workspace: A dedicated, quiet area where you can focus on delivering excellent customer service without interruptions.
• Tech-Savvy: Comfort with technology and ability to learn new systems quickly.
• Self-motivation & Independence: Ability to stay productive and manage your time effectively in a remote environment.
• Communication Skills: Strong verbal and written communication skills, especially in a virtual setting.
• Adaptability: Ability to adapt to changing technologies and procedures while working remotely.

Benefits

• Competitive hourly rate with opportunities for performance-based increases.
• Full health insurance coverage, including medical, dental, and vision plans.
• Supportive, engaging, and inclusive work environment with opportunities to grow and develop your skills.
• Abundant advancement opportunities within the organization.
• Cell Phone Benefits: $25/month per line for unlimited phone, text, and data (restrictions may apply).
• Referral for Life Program™: Earn residual bonuses for referring employees who join the team and remain with the company.