Description
We're building a world of health around every individual , shaping a more connected, convenient and compassionate health experience.
The Call Center Representative serves as the primary point of contact for members, providers, and plan sponsors, delivering exceptional customer service through phone, digital, and written communication channels.
Key Responsibilities
- Respond to member, provider, and plan sponsor inquiries through telephone, chat, email, and written correspondence.
- Resolve routine and complex customer concerns while delivering a high-quality customer experience.
- Accurately document customer interactions and maintain detailed records in applicable systems.
- Educate customers on plan benefits, policies, procedures, and self-service tools.
- Identify customer needs through active listening and provide personalized solutions and recommendations.
- Research and resolve claims, eligibility, billing, enrollment, and benefit-related issues.
- Coordinate escalations and referrals to appropriate departments when necessary.
- Demonstrate ownership of customer concerns through first-call resolution whenever possible.
- Maintain productivity, quality, compliance, and customer satisfaction standards.
- Support appeals, grievances, complaints, and authorization-related inquiries according to established guidelines.
- Utilize multiple systems and resources to investigate issues and provide accurate information.
- Adhere to HIPAA, regulatory requirements, and company policies regarding privacy and confidentiality.
Required Qualifications
- Minimum one year of customer service, call center, healthcare, insurance, or related experience preferred.
- Strong verbal and written communication skills.
- Ability to navigate multiple systems while speaking with customers.
- Demonstrated problem-solving, critical thinking, and decision-making abilities.
- Strong attention to detail and organizational skills.
- Ability to manage competing priorities in a fast-paced environment.
- Proficiency with Microsoft Office and customer relationship management systems.
Benefits
This full-time position is eligible for a comprehensive benefits package designed to support the physical, emotional, and financial well-being of colleagues and their families. The benefits for this position include medical, dental, and vision coverage, paid time off, retirement savings options, wellness programs, and other resources, based on eligibility.