CUSTOMER SERVICE REPRESENTATIVE
Department: Call Center
Reports To: Team Leader
Employment Type: Full-Time
Work Set-Up: Remote
Work Schedule: Monday-Friday, 11am to 7:30pm EST
ROLE SUMMARY
This role is essential in verifying insurance eligibility and benefits prior to patient services, ensuring accurate data entry and a smooth experience for both patients and internal teams. The ideal candidate thrives in a fast-paced, high-volume environment and delivers excellent customer service over the phone.
KEY RESPONSIBILITIES
· Verify insurance eligibility and benefits using payer portals, phone calls, and verification tools
· Update and maintain patient demographic and insurance data in the Electronic Health Record (EHR) system
· Document key benefit details including copayments, deductibles, coinsurance, and out-of-pocket maximums
· Communicate with patients to clarify insurance coverage and respond to basic inquiries
· Collaborate with clinical and billing teams regarding eligibility and authorization status
· Identify and resolve discrepancies in insurance information; escalate complex cases as needed
· Maintain compliance with HIPAA and patient privacy regulations
· Verify insurance eligibility and benefits using payer portals, phone calls, and verification tools
· Update and maintain patient demographic and insurance data in the Electronic Health Record (EHR) system
· Update and maintain patient demographic and insurance data in internal systems
· Document benefit details: copayments, deductibles, coinsurance, out-of-pocket maximums
· Communicate clearly and professionally with patients regarding coverage
· Collaborate with internal teams to resolve discrepancies and escalate complex cases
· Ensure compliance with HIPAA and privacy regulations
QUALIFICATIONS
· 1–2 years of experience in a healthcare call center or healthcare administration (insurance verification, patient registration, or medical billing)
· Familiarity with health insurance terminology: copay, deductible, coinsurance, HMO, PPO, subscriber
· Basic understanding of government-sponsored plans (Medicaid and Medicare) and their differences
· Proficient in navigating healthcare systems; experience with EHRs preferred
· Demonstrated excellence in customer service and client interaction
· Clear and professional communication skills
· Must successfully pass a criminal background check
PREFERRED QUALIFICATIONS
· Experience in high-volume healthcare settings (e.g., specialty practices, call center)
· Familiarity with major insurance payers
· Strong adherence to daily schedules, tasks, and performance metrics
· Ability to multitask effectively while maintaining high attention to detail
· Self-motivated, well-organized, and skilled in time management and problem-solving
· Capable of working independently and collaboratively within a team environment