Representative, Support Center III
New
J
JobgetherHealthcare Insurance
Based in the United StatesFull-TimeSenior
Salary13.41 - 29.06 USD per hour
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Job Details
- Experience
- At least 2 years of customer service, call center, and/or sales experience
- Required Skills
- SalesforceMicrosoft OfficeCustomer serviceHIPAACRM
Requirements
- At least 2 years of customer service, call center, and/or sales experience in a fast-paced, high-volume environment.
- Working knowledge of insurance products, particularly Medicaid, Medicare, and Marketplace enrollment processes.
- Strong customer service and research skills, with the ability to investigate issues.
- Experience with data processing and the ability to manage multiple tasks accurately and efficiently.
- Excellent verbal and written communication skills.
- Strong attention to detail, organization, time management, and follow-through.
- Ability to establish and maintain positive working relationships.
- Ability to protect confidential information and comply with HIPAA requirements.
- Proficiency with Microsoft Office and other relevant business software.
Responsibilities
- Provide Level III customer service through phone, chat, email, and administrative channels supporting multiple healthcare products and states.
- Research and resolve complex member and provider issues involving eligibility, benefits, claims, premiums, authorizations, appeals, contracting, credentialing, and related matters.
- Handle escalated and highly complex calls, including issues raised on behalf of leadership, while applying appropriate risk-based escalation protocols.
- Support appeals and grievances, problem research and resolution, and the development or maintenance of member and provider materials.
- Accurately document all member and provider interactions and complete required follow-up in a timely manner.
- Build rapport with customers, actively listen to their concerns, identify root causes, and provide compassionate, effective solutions.
- Support at least three lines of business, such as Medicare, Medicaid, Marketplace, or Medicare-Medicaid Plan services.
- Conduct research related to state, legislative, or regulatory inquiries and complete member satisfaction surveys when required.
- Collaborate with internal departments and support retention or inbound functions according to business needs and service-level requirements.
- Assist with training and supporting new and existing support center representatives.
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