Customer Service Representative

Randstad Enterprise is seeking a Customer Service Representative for a remote position. The role involves managing inbound inquiries about health plan benefits and claims, resolving customer issues, and maintaining accurate documentation of interactions.

Responsibilities:

• Answer and manage inbound inquiries regarding health plan benefits and claims, eligibility, medical and other healthcare procedures, billing and payments and other related topics from customers in a prompt, courteous manner. Conduct out-bound and/or return calls to customers as necessary
• Ask appropriate questions and listen actively to identify specific questions or issues to provide appropriate response and type of assistance the customer needs while documenting relevant information in a clear and concise manner in computer systems
• Communicate and partner with customers tactfully and empathetically to resolve issues, using clear language translating healthcare-related jargon and complex processes into simple, step-by-step instructions customers can comprehend and act upon
• Handle and process customer complaints/ grievances while applying appropriate conflict management skills to de-escalate potentially stressful situations
• Meet the performance goals established for the position in the areas of efficiency, accuracy, quality, member satisfaction and attendance. Adhere to all applicable department, organization and/or regulatory policies and procedures
• Read, comprehend, and verbalize processes and procedures of the organization and of health insurance coverage
• Accurately document customer interactions and transactions using the company's CRM system

Requirements:

• MUST Live in MD, VA, PA, DE
• Customer Service Experience: At least 1-2 years of experience in a customer service role, preferably in a healthcare setting
• Call Center Experience: Experience working in a call center environment at least 1 year, managing inbound calls, and handling high call volumes
• To be successful in this role, you should be customer-focused, detail-oriented and efficient
• Ability to work in a fast-paced environment and handle multiple tasks simultaneously while maintaining accuracy and attention to detail
• Customer service skills to create a positive interaction to ensure we are building trust and longevity with our members and providers
• Empathy and understanding to deal with sensitive health-related issues of our members
• Adherence to healthcare laws and regulations, particularly in relations to patient confidentiality and rights
• Ability to work regularly scheduled shifts within hours of operation including the training period, where lunches and breaks are scheduled, with the flexibility to adjust daily schedule, and work over-time and/or weekends, as needed
• This is a work from home position, which requires a quiet, private workspace without noise and distractions, and reliable internet connectivity provided through a wired connection with a minimum of 100 MBPS speed
• Bilingual in Spanish & English (validated via bilingual assessment upon offer acceptance) is a plus
• Healthcare Knowledge: Familiarity with healthcare and medical terminologies, as well as an understanding of health plan benefits and patient eligibility
• Knowledge of managed care, Commercial, Marketplace, Medicaid and/or Medicare programs; knowledge of medical policy benefits and exclusions is a plus