Research, review and respond to inquiries received from members and providers.
Employ active listening skills, demonstrate patience and empathy, and handle difficult calls tactfully, courteously, and professionally.
Effectively manage escalations within the department by ensuring appropriate accountability, sense of urgency, communication and follow through to closure.
Leverage company policies and procedures, benefits, claims, and eligibility to respond accurately to all inquiries.
Handle member complaints and complaint appeals.
Work with internal departments, vendors, business partners, providers, etc. to help coordinate problem solving in an effective and timely manner.
Demonstrate basic understanding of company billing guidelines and effectively interpret inquiries related to claims and claim payments.
Accurately document all calls.
Recognize trends and patterns in call types and engage leadership with suggested solutions.
Meet and maintain established department production and quality standards, on both an individual and team basis.
Assist members with navigating the member portal while encouraging them to becoming self-sufficient with our tools.
Demonstrate personal responsibility and accountability by meeting attendance and schedule adherence expectations.
Effectively excel in a virtual work environment through active participation in team huddles, supervisor 1:1s, instant messaging, and check-ins.

Minimum of 2 years of customer service experience supporting a commercial health plan (not just Medicare, Medicaid, or Pharmacy)
Experience collaborating and supporting business and operational units such as Claims, Medical Management and Appeals and Grievance.
Knowledge of medical and insurance industry terminology including CPT/ICD-10, HCPCS and Revenue Codes.
Excellent communication skills, both verbally and in writing, and can articulate and communicate complex topics to a broad audience.
Comfort working in a fast-paced, deadline-oriented work environment.
Strong attention to detail and problem-solving skills with a high level of accuracy.
Proficiency in Microsoft Office applications Word, Excel, Outlook OneNote, etc.
Prior experience using a CRM, preferably SalesForce.
Bonus: fluency in Spanish.

Competitive salary
Comprehensive health, dental, and vision insurance as well as life and disability
Retirement savings plan with company match
Generous time off/vacation
Professional development opportunities
Flexible and remote work environment

Commercial Health Call Center Representative

Key skills