Work Mode: Remote (Must have prior experience working remotely)
Shift: M-F 8-5 PST
Responsibilities:
Answer and manage inbound member and patient calls with professionalism, empathy, and excellent customer service.
Educate members regarding healthcare benefits, coverage, eligibility, referrals, authorizations, provider networks, claims, and member rights and responsibilities.
Research, troubleshoot, and resolve member issues, escalating complex concerns when appropriate.
Facilitate warm transfers and coordinate with internal departments to ensure seamless service.
Conduct follow-up communication and callbacks to ensure issue resolution and member satisfaction.
Serve as a liaison between members, patients, providers, and contracted health plans as needed.
Accurately document all member interactions, requests, updates, and resolutions in the managed care information system.
Maintain accurate records and process department-assigned requests in accordance with established protocols.
Utilize departmental resources, systems, and tools to support service delivery and productivity goals.
Adhere to call handling standards, customer service protocols, and approved communication scripts.
Maintain compliance with HIPAA, confidentiality requirements, and all applicable healthcare regulations.
Support departmental quality improvement initiatives and recommend process improvements when appropriate.
Monitor and contribute to achieving customer service, quality, and productivity metrics.
Requirements:
High School Diploma, GED, or equivalent.
Minimum of 3 years of customer service, member services, or related experience in a healthcare environment.
Strong verbal and written communication skills, including professional email etiquette, proper grammar, accurate documentation, clear formatting, and attention to detail.
Ability to handle sensitive situations with empathy, professionalism, and confidentiality.
Strong problem-solving, organizational, and multitasking skills.
Proficiency with computer systems, Microsoft Office applications, and data entry.
Ability to work effectively in a fast-paced environment with high call volumes, interruptions, and changing priorities.
Ability to collaborate as part of a team and provide cross-coverage as needed.
Ability to work standard business hours (8:00 AM – 5:00 PM PST) and occasional overtime when required.
Preferred Skills:
Experience with EPIC Tapestry, CRM systems, or similar healthcare technology platforms.
Experience working in managed care, health plans, or healthcare customer service environments.