Onboarding and enrollment support — guiding individuals through registration, account setup, and program onboarding; typically the highest-volume interaction type
Service and status inquiries — responding to questions about the status of requests, referrals, orders, or pending actions and explaining next steps clearly
Benefits and coverage questions — explaining what is included under a member's plan, addressing billing questions, and supporting plan or account changes
Care navigation and escalation — directing individuals to the appropriate clinical or specialist team when a question falls outside the representative's scope
Follow-up and outreach — returning missed calls and voicemails within SLA; a consistent part of daily workflow
Ticket and case management — logging, tracking, and resolving interactions across phone and digital channels using a CRM or case management platform
Multi-system navigation — working across multiple platforms simultaneously, including CRM, communication, and knowledge management tools
Quality and productivity targets — meeting defined KPIs for answer rate, handle time, wrap-up, and quality scores
Training participation — completing all required training phases, including self-paced learning, shadowing, nesting, and ongoing quality calibration

Prior customer service or call center experience (BPO), preferably in a healthcare, insurance, or benefits-related environment
Strong phone communication skills — clear, calm, and empathetic under pressure
Comfort navigating multiple systems and tools simultaneously
High attention to detail with the ability to follow structured workflows
Reliable, punctual, and able to thrive in a fast-paced, high-volume environment.

Healthcare Support Representative

Key skills