Sr. Call Center Specialist (Medical)

About the role

The Call Center Specialist serves as a key customer service representative, handling incoming calls from participants, providers, and other stakeholders while processing health insurance claims. This role requires adherence to eligibility, claims, and call policies and procedures, ensuring accurate and timely resolutions.

Responsibilities

• Answer high-volume incoming calls and assist with benefit, eligibility, billing, payment, and claims inquiries
• Document information accurately and communicate clearly with customers to resolve issues
• Process and review healthcare claims using multiple systems, ensuring proper application of benefits and compliance with policies
• Research and resolve claim-related problems, escalating when necessary
• Maintain strong customer relationships through professional and empathetic service
• Meet established performance metrics for quality, productivity, and attendance

Requirements

• Bachelor's degree required
• Minimum of 4 years of call center experience
• 4 years of claims processing experience preferred
• Knowledge of medical terminology preferred

Skills

• Strong analytical and problem-solving abilities
• Excellent verbal and written communication skills
• Proficiency in Microsoft Office Suite
• Ability to work in a fast-paced environment and manage multiple priorities