Customer Care Center Rep Full Time

1. About Our Client:

The organization operates as a not-for-profit health insurer and federal government contractor specializing in health insurance plans for individuals, families, seniors, and group plans for businesses of various sizes. It supports Medicare beneficiaries and manages benefits for millions of active-duty and retired military personnel across the U.S. and abroad, addressing challenges in healthcare access and claims processing with nearly 80 years of experience.

2. About the Opportunity:

The Customer Care Center Rep serves as the primary contact for members, brokers, and medical providers, delivering clear and accurate assistance regarding health plan benefits, eligibility, claims, and billing inquiries. This role is essential in resolving service requests and complaints efficiently while ensuring compliance with regulatory standards and maintaining high customer satisfaction.

3. Responsibilities:

• Serve as first point of contact for inquiries on benefits, eligibility, claims, billing, and healthcare services.

• Assist members in understanding benefits, eligibility, claim status, and billing issue resolution.

• Respond to provider inquiries concerning claims, authorizations, and reimbursement.

• Address and resolve service requests, complaints, and issues promptly.

• Collaborate with internal teams to manage complex inquiries.

• Research and resolve inquiries using multiple systems, providing clear written and verbal responses.

• Document interactions accurately for follow-up and quality assurance.

• Maintain thorough knowledge of health plan products, policies, procedures, and regulatory requirements.

• Ensure compliance with regulatory guidelines such as HIPAA and CMS.

• Perform other job-related duties as required.

4. Requirements:

• High School Diploma, GED, or equivalent experience.

• Minimum one year of customer service experience in a fast-paced, high-volume health insurance or healthcare call center.

• Strong verbal and written communication skills.

• Proven problem-solving abilities with empathy and patience.

• Capability to multitask, prioritize, and manage time effectively.

• High accuracy and attention to detail.

• Proficiency in Microsoft Office and web portal navigation.

• Availability to work a structured schedule based on Central Time Zone.

Preferred Qualifications:

• Familiarity with customer service software such as Facets or NTT.

• Basic knowledge of medical terminology.

Remote Work Requirements:

• High speed cable or fiber internet.

• Minimum 10 Mbps download and 1 Mbps upload speeds.

5. Pay Range and Compensation Package:

• Starting base salary: $20.50 per hour.

6. Benefits & Perks:

• Remote work options available.

• Performance bonus and merit increase opportunities.

• 401(k) plan with immediate full vesting and employer matching.

• Competitive paid time off.

• Health insurance, dental insurance, and telehealth services starting on day one.

• Professional and leadership development programs.

Equal Opportunity Statement: Our client is an equal opportunity employer. They celebrate diversity and are committed to creating an inclusive environment for all employees. All qualified applicants will receive consideration for employment without regard to race, color, religion, gender, gender identity or expression, sexual orientation, or national origin.

Note:

RemoteHunter is not the Employer of Record (EOR) for this role. Our purpose in this opportunity is to connect exceptional candidates with leading employers. We help job seekers worldwide discover roles that match their goals and guide them to complete their full application directly through the hiring company’s career page or ATS.