About the Company: We are seeking a dedicated Healthcare Customer Service Representative to join our team. This role involves assisting members with inquiries related to their insurance plans, eligibility, benefits, and claims. The ideal candidate will have a strong understanding of various insurance plan types and excellent communication skills.
About the Role: Healthcare Basics
• Recognize and understand various insurance plan types, including Commercial, Individual Products, HIX, and Government Plans (Medicaid/Medicare).
• Familiarity with common insurance terminology and procedures.
Key Responsibilities:
• Phone Skills
• Receive and respond to member inquiries via inbound calls using NICE inContact – Max Agent.
• Make outbound calls to members, vendors, and other departments.
• Follow established call flow processes for member interactions.
• Understand and apply protocols for using the language line for effective communication.
• * Eligibility and Enrollment
• Verify member status, including ID numbers and personal information, using Salesforce, CSC, and QNXT.
• Confirm member eligibility and plan effective dates.
• Manage member correspondence, including sending plan documents and updating demographics.
