Claims Customer Service Representative

Posted 12 months ago

Today’s Health Plan members and providers need professional and well trained customer service representatives. We are looking for customer service professionals who want to help our members, providers, and other healthcare advocates. You will provide personalized and company based principles to deliver solutions and answers to questions that relate to our healthcare products and solutions.

Position Description:

Customer Service Representatives are responsible for providing expertise and customer service support to members, customers, and / or providers; providing direct phone-based customer interaction to answer and resolve a wide variety of inquiries.

Primary Responsibilities:

  • Respond to and resolve customer service inquires and issues by identifying the topic and type of assistance the caller needs such as benefits, eligibility, claims and correspondence
  • Assist customers in website navigation and self-service options for their health plan
  • Own a problem through to resolution on behalf of a member in real time or through comprehensive and timely follow-up
  • Escalate member and provider issues to appropriate team members, as defined by our procedures
  • Provide education and status on previously submitted pre-authorizations or pre-determination requests
  • Meet the performance goals established for the position in the areas of: efficiency, call quality, customer satisfaction, first call resolution and attendance
  • Proficient problem solving skills
  • Proficient in translating healthcare-related terminology and complex processes into simple, step-by-step instructions customers can understand and act upon
  • Flexibility to customize approach to meet all types of member communication styles and personalities
  • Proficient conflict management skills to include ability to resolve issues and demonstrating personal resilience
  • Ability to work without constant direction from management
  • Basic tasks are completed without review by others


To be considered for this position, applicants need to meet the qualifications listed in this posting.

Required Qualifications:

  • High School Diploma / GED (or higher)
  • 1+ years of Customer Service experience
  • Ability to successfully complete the UGP training program within the required timeframe
  • Ability to work regularly scheduled shifts within our hours of operation, where lunches and breaks are scheduled, with the flexibility to adjust daily schedule, and work over-time and / or weekends, as needed

Preferred Qualifications:

  • Associate’s Degree (or higher)
  • Health care experience

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