Commercial Health Customer Service Representative
New
E
Evry HealthHealth insurance
We will only consider candidates in the United States who reside in the CST or EST time zones., CST or ESTFull-TimeJunior
Salary55,000 USD per year
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Job Details
- Experience
- At least two years of experience in customer service supporting a commercial health plan
- Required Skills
- SalesforceCustomer service
Requirements
- Have a high school diploma or equivalent.
- Have at least 2 years of customer service experience supporting commercial fully insured health plan business.
- Have working knowledge of commercial health plan benefits, eligibility, and claims processes.
- Demonstrate knowledge of CPT, ICD-10, HCPCS, and Revenue Codes.
- Have proficiency with Microsoft 365.
- Reside in the United States in the CST or EST time zone.
- Have a dedicated work area separate from other living areas that provides information privacy.
- Be able to keep company sensitive documents secure.
- Live in a location with existing high-speed internet service.
- Preferred: Associate's or Bachelor's degree in business, healthcare, or a related field.
- Preferred: Experience supporting Claims, Medical Management, and/or Appeals and Grievance functions.
- Preferred: Proficiency with Salesforce or a comparable CRM system.
- Preferred: Experience identifying or reporting call trends, or serving in an informal team lead or quality capacity.
Responsibilities
- Research, review, and respond to inbound and outbound member and provider inquiries about benefits, eligibility, claims, and billing.
- Resolve issues at first contact when possible and meet department turnaround times and metrics.
- Interpret and explain plan benefits, eligibility, cost-sharing, and claims payment decisions.
- Provide providers with claim status, prior authorization requirements, and payment details.
- Support pharmacy and wellness vendor inquiries.
- Own the initial intake and documentation of escalated member and provider situations.
- Collaborate with Claims, Medical Management, and other internal teams to resolve complex issues.
- Accurately document every interaction in the designated CRM system.
- Monitor call and inquiry patterns to surface trends to leadership.
- Assist members with portal navigation and promote digital self-sufficiency.
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