Commercial Health Call Center Representative- REMOTE (copy)
Remote · United States
Job Summary
Commercial Health Call Center Representative working remotely in the United States. Responsibilities include researching, reviewing, and responding to inquiries from members and providers; practicing active listening with empathy; handling escalations; applying policies, benefits, claims, and eligibility to respond accurately; assisting with member complaints and appeals; coordinating with internal departments and partners; interpreting billing guidelines and claims/payments; documenting calls; identifying trends; maintaining production and quality standards; helping members navigate the member portal; and participating in virtual team activities to ensure accountability and timely communication.
Required Qualifications
- Minimum of 2 years of customer service experience supporting a commercial health plan
- Experience collaborating with Claims, Medical Management and Appeals and Grievance
- Knowledge of CPT/ICD-10, HCPCS and Revenue Codes
- Excellent written and verbal communication skills
- Proficiency with Microsoft Office (Word, Excel, Outlook, OneNote)
- Experience with a CRM (preferably SalesForce)
- Bonus: fluency in Spanish
- Telecommuting requirement: remote in the United States with CST/EST time zones
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