Call Center Customer Service Representative

Key Responsibility

Respond to provider inquiries related to:

Benefits, eligibility, and claim status

Claim research and Explanation of Benefits (EOB)

Authorizations and provider directory inquiries

Navigation support and promotion of the provider self-service portal

Utilize internal systems and tools (via secure access methods) to retrieve and update information.

Document all interactions accurately in the designated call/chat tracking systems.

Escalate unresolved cases to the appropriate internal departments.

Complete all post-interaction tasks, including memos and detailed notes.

Communicate clearly, concisely, and professionally with healthcare providers.

Promote the effective use of self-service tools and digital resources.

Adhere to all privacy laws and regulatory compliance requirements.

Meet performance targets and service level agreements (SLAs).

Required Qualification

High school diploma or equivalent (mandatory)

Some college education or a completed degree (preferred)

Strong command of the English language (verbal and written)

Basic knowledge of Windows OS and Microsoft Office tools

Required Experience

1-2 years of customer service experience (preferably in healthcare or insurance)

Experience working in a call center or support environment

Familiarity with claims processing systems and provider portals (preferred)

Behavioral Attributes

Empathy: Understands and acknowledges provider concerns

Professionalism: Maintains a calm and respectful tone under pressure

Accountability: Takes ownership of responsibilities and outcomes

Adaptability: Flexible with process changes and system updates

Confidentiality: Complies with data privacy standards and regulations

Competencies

Excellent Communication: Ability to articulate clearly and listen actively

Problem Solving: Uses logic and reasoning to resolve issues effectively

Technical Proficiency: Comfortable navigating multiple systems and platforms

Time Management: Handles tasks efficiently while meeting deadlines

Customer Centricity: Focused on delivering a positive provider experience

Team Collaboration: Works well with others and contributes to team success