Customer Support Representative (Voice) – HMO Claims

Position Overview:

We are seeking a skilled and customer-oriented Customer Support Representative with experience in HMO/healthcare claims. The role involves handling voice calls, assisting members with their healthcare benefits, and resolving claims-related concerns while delivering excellent customer service.

Position Responsibilities:

• Handle inbound and outbound calls related to HMO inquiries and claims
• Assist members with benefit verification, eligibility, and claims status
• Explain coverage, policies, and procedures clearly and accurately
• Resolve customer concerns regarding claims processing, billing, and reimbursements
• Escalate complex or unresolved issues to the appropriate department
• Accurately document call details and transactions in the system
• Ensure compliance with company policies and healthcare regulations
• Maintain high-quality service standards and meet performance metrics

Position Requirements:

• At least a High School Diploma or equivalent (College level/graduate preferred)
• Minimum of 1–2 years’ experience in customer support, preferably in HMO or healthcare accounts
• Strong understanding of HMO processes, claims handling, and member services
• Excellent verbal communication skills is a must
• Ability to explain complex healthcare information in a simple and clear manner
• Good problem-solving and multitasking abilities
• Basic computer and CRM system knowledge
• Advanced English proficiency for both spoken and written is a must.