Commercial Health Call Center Representative- REMOTE (copy) Full Time NEW

Evry Health is seeking Call Center Representatives to support its significant growth. Call Center Representatives provide accurate and thorough information on commercial health plan benefits, eligibility, and claims. You will handle inbound and outbound calls as well as respond to email inquiries from our customers. In this role, you may be responsible for developing processes, call scripts, metrics, and desk top procedures. The role is responsible for delivering an exceptional customer service experience to our Evry members and providers.

This role reports to the Director of Operations and indirectly to the Vice President of Operations and should be comfortable partnering with senior leadership daily. At least two years of experience in customer service supporting a commercial health plan (not just Medicare, Medicaid, or Pharmacy) is required. Eligible candidates also must live in/work from the United States in either the CST or EST time zone.

About Evry Health And Globe Life

We are on a mission to bring humanity to health insurance. Our high-technology health plans expand benefits, increase access and transparency, and feature a personalized, human approach. We strive to ensure members live happier, healthier lives.

Evry Health is the major medical division of Globe Life (NYSE:GL). Globe Life has 16.8 million policies in force, and more than 3,000 corporate employees and 15,000 agents. For more than 45 consecutive years, Globe Life has earned an A (Excellent) rating or higher from A.M. Best Company.

Roles And Responsibilities

• Research, review and respond to inquiries received from members and providers
• Employ active listening skills, demonstrate patience and empathy, and handle difficult calls tactfully, courteously, and professionally
• Effectively manage escalations within the department by ensuring appropriate accountability, sense of urgency, communication and follow through to closure
• Leverage company policies and procedures, benefits, claims, and eligibility to respond accurately to all inquiries
• Handle member complaints and complaint appeals
• Work with internal departments, vendors, business partners, providers, etc. to help coordinate problem solving in an effective and timely manner
• Demonstrate basic understanding of company billing guidelines and effectively interpret inquiries related to claims and claim payments
• Accurately document all calls
• Recognize trends and patterns in call types and engage leadership with suggested solutions
• Meet and maintain established department production and quality standards, on both an individual and team basis
• Assist members with navigating the member portal while encouraging them to becoming self-sufficient with our tools
• Demonstrate personal responsibility and accountability by meeting attendance and schedule adherence expectations
• Effectively excel in a virtual work environment through active participation in team huddles, supervisor 1:1s, instant messaging, and check-ins

Experience And Skills Desired

• Minimum of 2 years of customer service experience supporting a commercial health plan (not just Medicare, Medicaid, or Pharmacy)
• Experience collaborating and supporting business and operational units such as Claims, Medical Management and Appeals and Grievance
• Knowledge of medical and insurance industry terminology including CPT/ICD-10, HCPCS and Revenue Codes
• Excellent communication skills, both verbally and in writing, and can articulate and communicate complex topics to a broad audience
• Comfort working in a fast-paced, deadline-oriented work environment
• Strong attention to detail and problem-solving skills with a high level of accuracy
• Proficiency in Microsoft Office applications Word, Excel, Outlook OneNote, etc
• Prior experience using a CRM, preferably SalesForce
• Bonus: fluency in Spanish

Telecommuting Requirements

• This is a remote position. Our whole company works remotely. Company headquarters are in Dallas, Texas
• Company business hours are weekdays 9-5 CST. We will only consider candidates in the United States who reside in the CST or EST time zones
• Required to have a dedicated work area established that is separate from other living areas and provides information privacy
• Ability to keep all company sensitive documents secure
• Must live in a location that receives an existing high-speed internet connection/service

Benefits Package

• Competitive salary
• Comprehensive health, dental, and vision insurance as well as life and disability
• Retirement savings plan with company match
• Generous time off/vacation
• Professional development opportunities
• Flexible and remote work environment

We may use artificial intelligence (AI) tools to support parts of the hiring process, such as reviewing applications, analyzing resumes, or assessing responses. These tools assist our recruitment team but do not replace human judgment. Final hiring decisions are ultimately made by humans. If you would like more information about how your data is processed, please contact us.