Customer Service Representative (Member/Provider Services)

About the Role:

Join our team as a Customer Service Representative and be the first point of contact for our valued members and healthcare providers. In this critical role, you'll be instrumental in ensuring a smooth and clear experience by providing accurate, timely, and empathetic support. If you have excellent communication skills and a passion for helping others, we'll provide the training you need—no prior healthcare experience is required!

Key Responsibilities:

• Handle multi-channel communication via incoming calls, live chats, and emails from both members and healthcare providers.
• Focus on answering complex questions related to insurance benefits (eligibility, coverage details), claims status and processing , or guiding users through enrollment procedures .
• Document all customer interactions accurately and thoroughly in the customer relationship management (CRM) system.
• Resolve customer issues effectively and efficiently on the first contact whenever possible, or escalate to a specialist team when necessary.
• Maintain strict adherence to privacy regulations, including HIPAA, ensuring all protected health information is handled securely.
• Participate in ongoing training to stay current on product changes, process updates, and regulatory requirements.

Requirements:

• High School Diploma or GED required.
• Exceptional verbal and written communication skills are mandatory for professional and clear interactions.
• Demonstrated ability to listen actively, empathize, and quickly navigate systems to find information.
• Proficiency with basic computer applications (Microsoft Office Suite, web browsers) and ability to type accurately.
• Reliable work attendance and the ability to work assigned shifts within contact center operating hours.
• No prior healthcare experience is strictly required; we will train the right candidate!