Job Description
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
Ā Recognize and understand various insurance plan types, including Commercial, Individual Products, HIX, and Government Plans (Medicaid/Medicare).
Ā Familiarity with common insurance terminology and procedures.
Key Responsibilities:
Ā Phone Skills
Ā Receive and respond to member inquiries via inbound calls using NICE inContact - Max Agent.
Ā Make outbound calls to members, vendors, and other departments.
Ā Follow established call flow processes for member interactions.
Ā Understand and apply protocols for using the language line for effective communication.
Ā * Eligibility and Enrollment
Ā Verify member status, including ID numbers and personal information, using Salesforce, CSC, and QNXT.
Ā Confirm member eligibility and plan effective dates.
Ā Manage member correspondence, including sending plan documents and updating demographics.
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