Customer Service Representative

Participant Advocate / Customer Service Representative

Participant Advocate / Customer Service Representative

Industry: Healthcare Benefits / Insurance

Location (City, State): Rockville, MD

Assignment Type: Contract-to-Hire; anticipated conversion after approximately 68 months

Pay: $23.00$27.00 per hour

Work Schedule: Full-time, 40 hours per week, Monday through Friday. Training hours are 8:00 AM5:00 PM, with the potential for a 10:00 AM7:00 PM schedule after training. This is a fully onsite position, five days per week.

Benefits: This position is eligible for medical, dental, vision, and 401(k).

About Our Client: Addison Group is hiring on behalf of our client, a well-established organization within the healthcare benefits industry. Their Customer Service team supports plan participants by answering questions, resolving concerns, and helping individuals navigate benefits, eligibility, claims, and other healthcare-related processes.

This is an excellent opportunity for a customer-focused professional who enjoys helping others, can thrive in a structured environment, and is comfortable managing a high volume of inquiries while maintaining accuracy and professionalism.

The Participant Advocate will serve as a primary point of contact for individuals seeking assistance with their healthcare benefits. This person will handle incoming questions by phone, email, written correspondence, and in person while researching concerns and providing clear, accurate information.

The ideal candidate will bring strong customer service experience, excellent communication skills, and the ability to follow established procedures while troubleshooting more complex participant concerns.

Key Responsibilities:

• Respond to participant inquiries through phone calls, emails, written correspondence, and occasional in-person interactions.
• Assist individuals with questions related to healthcare eligibility, benefits, claims, payments, denials, and self-payment responsibilities.
• Research participant concerns and identify accurate information and appropriate resolutions.
• Explain benefit information and claim outcomes in a clear and easy-to-understand manner.
• Verify eligibility and coordinate updates or corrections with internal teams and outside partners.
• Partner with vendors, providers, employers, and internal departments to resolve participant issues.
• Maintain detailed and accurate documentation of participant interactions.
• Assist with forms, enrollment-related questions, disability requests, and other participant processes.
• Guide participants through available online tools and resources.
• Escalate more complex issues to the appropriate team members when necessary.
• Learn and apply benefit plans, internal systems, processes, and established service procedures.

Qualifications:

• At least 1 year of recent experience in customer service, scheduling, reception, or a similar client-facing role.
• Experience within healthcare, insurance, benefits administration, a TPA, or a related industry is strongly preferred.
• Previous call center experience and familiarity with customer service metrics are highly preferred.
• Ability to type at least 40 WPM; candidates should be comfortable completing a typing assessment.
• Strong verbal and written communication skills with the ability to explain detailed information clearly.
• Professional, empathetic, dependable, and customer-focused approach.
• Strong attention to detail and ability to investigate and resolve issues.
• Comfortable working within established procedures and structured workflows.
• Proficiency with Microsoft Office applications.
• High School Diploma or equivalent required; an Associate's degree is preferred.

Additional Details:

This is a highly structured, full-time onsite position where reliability, punctuality, and consistent attendance are essential. Candidates should be comfortable working a set schedule with limited flexibility for recurring schedule changes or extended planned absences.

The interview process includes onsite skills assessments, including typing and customer service evaluations, followed by an in-person interview for candidates who successfully complete the required assessments.

Training lasts approximately 68 weeks and begins in a classroom-style environment. Training includes instructor-led learning sessions, system navigation, call-flow instruction, and supervised practice handling live participant calls. As training progresses, employees will gradually take on more responsibility until they are prepared to independently manage participant inquiries.

Candidates should be prepared to remain attentive and engaged throughout training and follow established policies regarding attendance, participation, and use of personal devices.

When submitting candidates, please include details regarding their previous call center environment and performance metrics, such as call volume, average handle time, quality scores, service levels, or other applicable KPIs.

Perks:

• Opportunity to transition into a long-term, permanent position.
• Comprehensive benefits package available upon conversion, including fully employer-paid medical, dental, vision, and prescription coverage for eligible employees and dependents.
• Retirement benefits, including employer-funded pension and annuity contributions.
• Paid holidays, sick time, personal days, and vacation accrual.
• Employer-paid life insurance and short-term disability benefits.
• Onsite amenities, including a caf and gym.
• Casual and professional workplace environment.
• Opportunity to build valuable experience within healthcare benefits and participant advocacy.

Addison Group is an Equal Opportunity Employer. Addison Group provides equal employment opportunities (EEO) to all employees and applicants for employment without regard to race, color, religion, gender, sexual orientation, national origin, age, disability, genetic information, marital status, amnesty, or status as a covered veteran in accordance with applicable federal, state and local laws. Addison Group complies with applicable state and local laws governing non-discrimination in employment in every location in which the company has facilities. Reasonable accommodation is available for qualified individuals with disabilities, upon request.