Commercial Health Call Center Representative- REMOTE

Roles and Responsibilities

• Research, review and respond to inquiries received from members and providers.
• Employ active listening skills, demonstrate patience and empathy, and handle difficult calls tactfully, courteously, and professionally.
• Effectively manage escalations within the department by ensuring appropriate accountability, sense of urgency, communication and follow through to closure.
• Leverage company policies and procedures, benefits, claims, and eligibility to respond accurately to all inquiries.
• Handle member complaints and complaint appeals.
• Work with internal departments, vendors, business partners, providers, etc. to help coordinate problem solving in an effective and timely manner.
• Demonstrate basic understanding of company billing guidelines and effectively interpret inquiries related to claims and claim payments.
• Accurately document all calls.
• Recognize trends and patterns in call types and engage leadership with suggested solutions.
• Meet and maintain established department production and quality standards, on both an individual and team basis.
• Assist members with navigating the member portal while encouraging them to becoming self-sufficient with our tools.
• Demonstrate personal responsibility and accountability by meeting attendance and schedule adherence expectations.
• Effectively excel in a virtual work environment through active participation in team huddles, supervisor 1:1s, instant messaging, and check-ins.

Experience and Skills Desired

• Minimum of 2 years of customer service experience supporting a commercial health plan (not just Medicare, Medicaid, or Pharmacy)
• Experience collaborating and supporting business and operational units such as Claims, Medical Management and Appeals and Grievance.
• Knowledge of medical and insurance industry terminology including CPT/ICD-10, HCPCS and Revenue Codes.
• Excellent communication skills, both verbally and in writing, and can articulate and communicate complex topics to a broad audience.
• Comfort working in a fast-paced, deadline-oriented work environment.
• Strong attention to detail and problem-solving skills with a high level of accuracy.
• Proficiency in Microsoft Office applications Word, Excel, Outlook OneNote, etc.
• Prior experience using a CRM, preferably SalesForce.
• Bonus: fluency in Spanish.

Telecommuting Requirements

• This is a remote position. Our whole company works remotely. Company headquarters are in Dallas, Texas.
• Company business hours are weekdays 9-5 CST. We will only consider candidates in the United States who reside in the CST or EST time zones.
• Required to have a dedicated work area established that is separate from other living areas and provides information privacy.
• Ability to keep all company sensitive documents secure.
• Must live in a location that receives an existing high-speed internet connection/service.

Benefits Package

• Competitive salary
• Comprehensive health, dental, and vision insurance as well as life and disability
• Retirement savings plan with company match
• Generous time off/vacation
• Professional development opportunities
• Flexible and remote work environment