This is a Fully Remote Job
About Our Client:
The organization operates within the healthcare industry, providing Medicaid, Medicare, and Marketplace health insurance products across multiple states. It addresses challenges related to member and provider engagement, service quality, and issue resolution by delivering support and managing interactions through various communication channels.
About the Opportunity:
The REPRESENTATIVE, SUPPORT CENTER II is responsible for delivering level II customer service support to members and providers. This role focuses on resolving issues, improving the member and provider experience, and supporting retention and quality improvement initiatives. The position contributes to the organization by ensuring effective communication and problem resolution, which supports ongoing engagement and satisfaction.
Responsibilities:
- Provide service support to members and providers via phone, chat, email, and administrative tasks.
- Address appeals, grievances, problem research, and resolution.
- Assist with process improvement and member/provider retention.
- Deliver excellent customer service aiming for first call resolution.
- Document calls accurately across multiple platforms.
- Work scheduled shifts, follow protocols, and accommodate overtime or weekends as needed.
- Build rapport and respond empathetically to customer needs.
- Capture relevant information to resolve inquiries and concerns.
- Meet or exceed performance goals related to call quality, attendance, and adherence.
- Engage and collaborate with internal and external stakeholders.
- Take ownership of solutioning and timely follow-up.
- Support inquiries related to benefits, claims, premiums, provider portals, and eligibility.
- Evaluate risk and determine escalation paths.
- Demonstrate proficiency in at least two lines of business.
- Manage multiple communication channels effectively.
- Understand provider service inquiries concerning claims, authorizations, appeals, contracting, and credentialing.
Requirements:
- Minimum 1 year of customer service, call center, or sales experience in a high-volume environment or equivalent education and experience.
- Strong customer service skills.
- Experience with data processing.
- Attention to detail, organization, and multitasking abilities.
- Ability to maintain confidentiality and comply with HIPAA.
- Ability to maintain positive work relationships with coworkers, members, providers, and customers.
- Effective verbal and written communication skills.
- Proficiency with Microsoft Office and applicable software.
Pay Range and Compensation Package:
- The pay range and compensation package for this role will be determined based on the candidate's experience, skills, and other relevant factors.
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:
TalentHop is a recruitment partner of this role. Please note that all employment decisions, including candidate assessment, interviews, hiring, compensation, and employment terms, are made exclusively by the hiring employer.