Call Center Customer Service Representative (CSR)

The Call Center Customer Service Representative (CSR) supports Medicare beneficiaries, authorized representatives, employers, insurers, healthcare providers, and other stakeholders with questions related to other health insurance coverage and Medicare's payment responsibility.

The CSR reviews and updates beneficiary insurance information, helps determine the appropriate order of payment, and explains Medicare Secondary Payer (MSP) requirements. This role requires accurate documentation, strong customer service skills, and strict compliance with Centers for Medicare (CMS), HIPAA, privacy, security, and program requirements.

Job Responsibilities:

• Handle inbound calls concerning Medicare Coordination of Benefits and Medicare Secondary Payer matters.
• Assist beneficiaries, authorized representatives, employers, insurers, providers, attorneys, and other approved callers.
• Collect, verify, research, and update other health insurance information, including Employer group health plan coverage and non-group health plan coverage.
• Apply approved Medicare Secondary Payer rules and procedures to determine whether Medicare may pay primary or secondary.
• Accurately enter and update insurance records, call details, and supporting information.
• Protect personally identifiable information and protected health information in accordance with HIPAA and applicable privacy and security requirements.
• Meet established standards for quality, attendance, and schedule adherence.
• Complete required training and remain current on Medicare COB and MSP program updates.

Education / Equivalent Training:

• High School Graduate or equivalent required.
• Bachelor's degree or equivalent preferred.

Experience:

• Six months in a call center, customer service, healthcare, health insurance or related environment.
• Must be able to type 20 WPM, 30 WPM preferred.
• Ability to explain insurance and Medicare information in clear, easy-to-understand language.
• Demonstrated empathy, professionalism, active listening, and de-escalation skills.
• Strong attention to detail and accurate data-entry abilities.
• Ability to navigate several applications while speaking with callers and documenting interactions.
• Ability to work independently and protect sensitive information in a remote setting.

Remote Work Requirements:

• Maintain a private, quiet, and secure workspace free from unauthorized individuals and interruptions.
• Maintain reliable high-speed internet that meets technical requirements.
• Use employer-provided equipment, authentication tools, and communication systems as directed.
• Prevent viewing, discussion, printing, recording, or storage of beneficiary information by unauthorized individuals.
• Comply with clean-desk, confidentiality, information-security, and remote-work requirements.
• Be available for assigned shifts, which may include evenings or overtime based on program needs.

Benefits:

• Medical plan options
• Dental plan options
• Vision plan
• 401(k) plan with company match
• Paid time off plans, including vacation, sick and personal time, holidays, paid parental, military, bereavement and jury duty leave
• Short and long-term disability benefits
• Life, accidental death and dismemberment, personal accident, critical illness and business travel and accident insurance