Experienced Health/Medical Customer Service Representatives for Health Insurance Company

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Young female doctor sitting at her desk and talking on the phone

Health/Medical Insurance Company Seeking Experienced Customer Service Representatives

Position Summary:

The Health/Medical Customer Service Representative provides prompt, accurate and courteous customer service for multiple lines of business to Policy Owners, Agents, and Healthcare Providers. Superior telephone interaction skills. Treats all callers with kindness and professionalism. Warm, Customer-friendly, positive attitude.

Key Functions:

  • Respond to calls received and use the necessary means to provide the requested information to Providers, Policyholders, and Agents.
  • Accurately note the inquiry and any action taken.
  • Answer Customer / Agent / Provider inquiries by either verbal or written means.
  • Receives incoming calls from Insureds, Sales Agents and Providers. Makes outgoing calls to Insureds, Sales Agents and Providers. Resolves service issues by listening and clarifying the Customer’s concerns, determining the cause of the problem and explaining the best solution. Works to resolve all issues on the Customer’s first call, without requiring a call back from the Customer. Follows up on calls as needed.
  • Must meet department standards for attendance and timeliness. Meets or exceeds call goals of 375 calls per week. Meets department standards for efficiency. Follows Department policies and procedures. Documents all calls handled in a clear, compliant manner.
  • Verifies benefit information for Insureds and Providers. Maintains and updates Customer’s account information with requested changes. Communicates needed work requests to Policyowner Services, such as cancellations, bank drafts changes, address changes, refunds, quoting, etc. Works with other internal departments such as Claims Department to resolve claim issues, Finance to research outstanding check issues, etc.
  • Able to read and interpret policy contracts including information about benefits, provisions, exclusions, limitations and waiting periods to help Customers understand the products they have purchased. Able to understand and discuss claims status based on contract provisions. Able to identify system errors or procedure errors based on contract provisions. Educates Providers on the unique features of our innovative products.
  • Attempts to conserve business by giving Customers a detailed explanation of current coverage and coverage options that could be available. Recommends potential products or services to Customers after analyzing the Customer’s needs.
  • Strong knowledge of all products serviced, as well as knowledge of Medical Terminology, Underwriting Guidelines, ICD9, ICD10, and CPT codes. Multi-tasking ability required. Excellent written and verbal skills required. Demonstrated ability to handle difficult, emotional or angry calls calmly and with courtesy.
  • Other duties as may be assigned.

Education, Training, and Certification or Licenses Required:

High School diploma or equivalent required. Two year college or vocational school training in a professional, specialized, or general field preferred; or equivalent combination of education and experience.

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