Customer Service Representative

Job Description

Job Title:Customer Service Representative Healthcare Account

Job Summary:

We are looking for aCustomer Service Representativeto support ourhealthcare account. The ideal candidate will assist members and healthcare providers by providing accurate information, resolving concerns, and delivering an exceptional customer service experience in a professional and empathetic manner.

Key Responsibilities:

• Respond to inbound calls, emails, or chats regardinghealth insurance policies, claims, benefits, and billing.
• Provide accurate information and solutions based onhealthcare policies and procedures.
• Assist customers witheligibility, coverage, authorizations, and appointment scheduling.
• Handlemember inquiries and complaintswith empathy, efficiency, and professionalism.
• Document customer interactions using internalCRM or ticketing tools.
• Escalate complex issues to appropriate departments as needed.
• Ensure compliance withHIPAA regulationsand other healthcare standards.
• Meet or exceedperformance metricsincluding customer satisfaction, response time, and call handling.

Qualifications:

• Graduate of any medical/healthcare-related course(e.g., Nursing, Pharmacy, Medical Technology, Public Health, Biology, Psychology).
• 1+ year of customer service experience, preferably in a healthcare or insurance environment.
• Strong communication skills inEnglish(verbal and written).
• Basic knowledge ofmedical terminology, insurance claims, or healthcare processesis preferred.
• Proficiency in using computers, CRM systems, and multitasking between tools.
• Ability to remain calm and professional in stressful situations.

Preferred Qualifications:

• Experience working in aBPO or call centerfor a healthcare account.
• Familiarity withHIPAA compliance.
• Knowledge of tools such asAvaya, Salesforce, Fresh Caller, or Zendesk.