Customer Service Representative (Healthcare Account)

Job Title: Customer Service Representative – Healthcare Account

Job Summary:

We are looking for a Customer Service Representative to support our healthcare account. The ideal candidate will assist members and healthcare providers by providing accurate information, resolving concerns, and delivering an exceptional customer service experience in a professional and empathetic manner.

Key Responsibilities:

• Respond to inbound calls, emails, or chats regarding health insurance policies, claims, benefits, and billing.
• Provide accurate information and solutions based on healthcare policies and procedures.
• Assist customers with eligibility, coverage, authorizations, and appointment scheduling.
• Handle member inquiries and complaints with empathy, efficiency, and professionalism.
• Document customer interactions using internal CRM or ticketing tools.
• Escalate complex issues to appropriate departments as needed.
• Ensure compliance with HIPAA regulations and other healthcare standards.
• Meet or exceed performance metrics including customer satisfaction, response time, and call handling.

Qualifications:

• Graduate of any medical/healthcare-related course (e.g., Nursing, Pharmacy, Medical Technology, Public Health, Biology, Psychology).
• 1+ year of customer service experience, preferably in a healthcare or insurance environment.
• Strong communication skills in English (verbal and written).
• Basic knowledge of medical terminology, insurance claims, or healthcare processes is preferred.
• Proficiency in using computers, CRM systems, and multitasking between tools.
• Ability to remain calm and professional in stressful situations.

Preferred Qualifications:

• Experience working in a BPO or call center for a healthcare account.
• Familiarity with HIPAA compliance.
• Knowledge of tools such as Avaya, Salesforce, Fresh Caller or Zendesk.