Remote - Healthcare Call Center Representative

It's fun to work in a company where people truly BELIEVE in what they are doing!

We're committed to bringing passion and customer focus to the business.

Healthcare Call Center Representative 

Location: Remote (Virtual Environment)
Company: Trusted Leader in Healthcare Services

Are you passionate about delivering exceptional customer service and building meaningful relationships?

As a Healthcare Call Center Representative, you will be the cornerstone of our commitment to customer satisfaction. In this role, you will provide comprehensive support and information to members, providers, and patients, ensuring they get the most out of their healthcare plans and services. By adhering to compliance guidelines and embodying our company values, your objective is to deliver extraordinary service while building trust and rapport with current and prospective members.

What You'll Be Doing:

• Customer Interactions:

  • Manage inquiries in areas such as Member Services, Medicare, and Billing.

  • Represent our client professionally by addressing and documenting all incoming queries, including complex calls related to specialized product lines.

• Quality Service:

  • 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.

• Problem Resolution:

  • Analyze and evaluate customer issues to initiate and coordinate service recovery measures.

  • Document all member interactions meticulously following established procedures.

• Healthcare Knowledge

  • 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. 

• Operational Excellence

  • 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.

• Performance Metrics:

  • Monitor and achieve Contact Center KPIs, including call handling, first call resolution, and member retention.

• Compliance and Ethics:

  • 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. 

• Tools and Systems: 

  • Use multiple systems/screens while assisting callers effectively

  • Navigate CRM, EMR/EHR, and ticketing platforms effectively

What You Bring:

• Experience:

  • Minimum of two (2) years of customer service or healthcare member-interaction experience.

  • Previous call center experience and/or prior experience in the health insurance industry (preferred).

• Education:

  • High School Diploma or GED required.

• Skills:

  • 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.