Customer Service Representative

Job Description

Job Description

Job Summary

Customer Service Representative to join a leading healthcare organization in Howell, MI . The ideal candidate will have recent healthcare customer service or call center experience and be responsible for assisting members with inquiries, resolving issues, educating customers on healthcare benefits, and delivering exceptional service while maintaining HIPAA compliance.

Key Responsibilities

• Respond to customer inquiries via phone, mail, and in person in a professional and timely manner.
• Research, investigate, and resolve member questions, complaints, and service-related issues.
• Educate members on healthcare plans, benefits, policies, procedures, and coverage options.
• Accurately document customer interactions and maintain detailed records.
• Collaborate with internal departments and healthcare providers to ensure timely issue resolution.
• Monitor assigned cases and provide prompt follow-up until resolution.
• Maintain confidentiality and comply with HIPAA and organizational policies.
• Identify service trends and recommend process improvements to enhance the customer experience.
• Participate in training sessions, departmental initiatives, and other assigned projects.

Required Qualifications

• Minimum 2 years of recent Customer Service or Call Center experience within the last 3 years.
• Healthcare customer service experience preferred.
• Knowledge of HMO, PPO, POS health plans, claims processing, and health insurance .
• Strong verbal and written communication skills.
• Excellent customer service, problem-solving, and multitasking abilities.
• Proficiency with Microsoft Office applications.
• Ability to work independently and as part of a team in a fast-paced environment.

Education

• Associate's Degree OR
• Four (4) years of related customer service experience in lieu of a degree.
• Medical Terminology course required within six months of employment.

Preferred Qualifications

• Experience in a hospital, medical office, health plan, or insurance environment.
• Knowledge of HIPAA regulations and healthcare terminology.
• Strong organizational and documentation skills.

Company Description

Pride Health offers eligible employee’s comprehensive healthcare coverage (medical, dental, and vision plans), supplemental coverage (accident insurance, critical illness insurance and hospital indemnity), 401(k)-retirement savings, life & disability insurance, an employee assistance program, legal support, pet insurance and employee discounts with preferred vendors.

Equal Employment Opportunity
Pride Health is an equal opportunity employer. We do not discriminate on the basis of the race, religious creed, color, national origin, ancestry, physical disability, mental disability, reproductive health decision making, medical condition, genetic information, marital status, sex, gender, gender identity, gender expression, age, sexual orientation, veteran or military status, or any other characteristic protected by applicable federal, state, or local law.

Fair Chance Employment
Pride Health is a Fair Chance employer. We consider all qualified applicants, including those with criminal histories, in a manner consistent with applicable state and local Fair Chance laws and ordinances, including, the California Fair Chance Act and all applicable local Fair Chance ordinances.

Accommodations
We are committed to providing reasonable accommodations to applicants and employees with disabilities. If you require a reasonable accommodation to participate in the application or interview process, or to perform the essential functions of this role, please contact us.

Only applicable for San Francisco Candidates: Under the San Francisco Lactation in the Workplace Ordinance, we will provide written notice of lactation accommodation rights, and this notice will automatically be given upon hiring, any inquiry of parental leave or lactation accommodation.

Only applicable for Kentucky positions: For this type of employment, state law requires a criminal record check as a condition of employment. This applies to direct care staff (Examples: RN, LPN, Nurse Aides, Therapists) referred to Kentucky nursing facilities, assisted living communities, or long-term care facilities, in accordance with KRS 216.793.

Company Description

Pride Health offers eligible employee’s comprehensive healthcare coverage (medical, dental, and vision plans), supplemental coverage (accident insurance, critical illness insurance and hospital indemnity), 401(k)-retirement savings, life & disability insurance, an employee assistance program, legal support, pet insurance and employee discounts with preferred vendors.\r\n\r\nEqual Employment Opportunity\r\nPride Health is an equal opportunity employer. We do not discriminate on the basis of the race, religious creed, color, national origin, ancestry, physical disability, mental disability, reproductive health decision making, medical condition, genetic information, marital status, sex, gender, gender identity, gender expression, age, sexual orientation, veteran or military status, or any other characteristic protected by applicable federal, state, or local law.\r\n\r\nFair Chance Employment\r\nPride Health is a Fair Chance employer. We consider all qualified applicants, including those with criminal histories, in a manner consistent with applicable state and local Fair Chance laws and ordinances, including, the California Fair Chance Act and all applicable local Fair Chance ordinances.\r\n\r\nAccommodations\r\nWe are committed to providing reasonable accommodations to applicants and employees with disabilities. If you require a reasonable accommodation to participate in the application or interview process, or to perform the essential functions of this role, please contact us.\r\n\r\nOnly applicable for San Francisco Candidates: Under the San Francisco Lactation in the Workplace Ordinance, we will provide written notice of lactation accommodation rights, and this notice will automatically be given upon hiring, any inquiry of parental leave or lactation accommodation.\r\n\r\nOnly applicable for Kentucky positions: For this type of employment, state law requires a criminal record check as a condition of employment. This applies to direct care staff (Examples: RN, LPN, Nurse Aides, Therapists) referred to Kentucky nursing facilities, assisted living communities, or long-term care facilities, in accordance with KRS 216.793.