Claims Customer Service Representative

Currently seeking Healthcare Claims Customer Service Representatives! (MUST HAVE Healthcare claims experience/Medicare/Medicaid) Direct Hire!! "Lots of Growth opportunities" Key Responsibilities: Customer Service: Handle high volume inbound customer inquiries via phone, ensuring prompt and professional service. Provide accurate and comprehensive information about insurance policies, benefits, and coverage. Resolve customer complaints and issues within a single call whenever possible, aiming for one call resolution. Claim Adjudication: Demonstrate a thorough understanding of healthcare and other applicable insurance claim adjudication processes to accurately address and resolve policyholder inquiries and issues. Assist providers with claim(s) processing, including guidance for claim submission, clarifying reimbursement procedures, and ensuring compliance with Medicare and industry guidelines. Educate customers about the claim adjudication process and policy details Daily Operations: Maintain accurate and up-to-date records of customer interactions and transactions. Collaborate with other departments, including Medicare Supplement Claims Examiners, Ancillary Examiners, and other stakeholders to ensure seamless service delivery. Identify and escalate complex issues to the appropriate department for further resolution. Vaco has partnered with a well-established insurance organization to fill a Customer Service Representative role supporting policyholders and providers. This position serves as a primary point of contact for high-volume inbound inquiries, delivering accurate information, resolving issues efficiently, and ensuring an exceptional customer experience. The ideal candidate will have strong knowledge of Medicare Supplement insurance and claims adjudication processes, with a focus on achieving one-call resolution. Fluency in both English and Spanish is required. If you are a detail-oriented, empathetic professional with insurance industry experience—apply today. Responsibilities Handle high-volume inbound calls from policyholders and providers, delivering prompt and professional service Provide accurate and detailed information regarding insurance policies, benefits, coverage, and claims Resolve customer concerns efficiently, striving for one-call resolution whenever possible Assist providers with claim processing, including claim submission guidance and clarification of reimbursement procedures Demonstrate knowledge of Medicare Supplement insurance and healthcare claim adjudication processes Educate customers on claim determinations, policy provisions, and CMS-related guidelines Maintain accurate documentation of all customer interactions within customer service systems Collaborate with Claims Examiners and other internal departments to ensure timely and seamless issue resolution Identify and escalate complex inquiries appropriately Uphold company standards of accuracy, integrity, empathy, and professionalism in every interaction Stay current on CMS guidelines, Medicare Supplement updates, and internal policy changes Qualifications High school diploma or equivalent required Minimum 3 years of customer service experience, preferably in the insurance or healthcare industry Strong knowledge of Medicare Supplement insurance and healthcare claim adjudication processes preferred Experience handling high-volume inbound calls with a focus on first-call resolution Excellent verbal and written communication skills Determining compensation for this role (and others) at Vaco/Highspring depends upon a wide array of factors including but not limited to the individual’s skill sets, experience and training, licensure and certifications, office location and other geographic considerations, as well as other business and organizational needs. With that said, as required by local law in geographies that require salary range disclosure, Vaco/Highspring notes the salary range for the role is noted in this job posting. The individual may also be eligible for discretionary bonuses, and can participate in medical, dental, and vision benefits as well as the company’s 401(k) retirement plan. Vaco by Highspring values a diverse workplace and strongly encourages women, people of color, LGBTQ+ individuals, people with disabilities, members of ethnic minorities, foreign-born residents, and veterans to apply. EEO Notice Vaco by Highspring is an Equal Opportunity Employer and does not discriminate against any employee or applicant for employment because of race (including but not limited to traits historically associated with race such as hair texture and hair style), color, sex (includes pregnancy or related conditions), religion or creed, national origin, citizenship, age, disability, status as a veteran, union membership, ethnicity, gender, gender identity, gender expression, sexual orientation, marital status, political affiliation, or any other protected characteristics as required by federal, state or local law. Vaco by Highspring and its parents, affiliates, and subsidiaries are committed to the full inclusion of all qualified individuals. As part of this commitment, Vaco by Highspring and its parents, affiliates, and subsidiaries will ensure that persons with disabilities are provided reasonable accommodations. If reasonable accommodation is needed to participate in the job application or interview process, to perform essential job functions, and/or to receive other benefits and privileges of employment, please contact View email address on click.appcast.io . Vaco by Highspring also wants all applicants to know their rights that workplace discrimination is illegal. By submitting to this position, you agree that you will be giving Vaco by Highspring the exclusive right to present your as a candidate for the foregoing employment opportunity. You further agree that you have represented information about yourself accurately and have not affirmatively misrepresented your qualifications. You also agree to maintain as confidential, to the fullest extent permitted by law, any information you learn from Vaco by Highspring about the position and you will limit disclosure of information about the position only to the extent necessary to perform any obligations in furtherance of your application. In exchange, Vaco by Highspring agrees to exercise reasonable efforts to represent you through all solicitation, job screening and resume dispersal. Privacy Notice Vaco by Highspring and its parents, affiliates, and subsidiaries (“we,” “our,” or “Vaco by Highspring”) respects your privacy and are committed to providing transparent notice of our policies. California residents may access Vaco by Highspring HR Notice at Collection for California Applicants and Employees here. Virginia residents may access our state specific policies here. Residents of all other states may access our policies here. Canadian residents may access our policies in English here and in French here. Residents of countries governed by GDPR may access our policies here. Pay Transparency Notice Determining compensation for this role (and others) at Vaco by Highspring depends upon a wide array of factors including but not limited to: the individual’s skill sets, experience and training; licensure and certification requirements; office location and other geographic considerations; other business and organizational needs. With that said, as required by local law, Vaco by Highspring believes that the following salary range referenced above reasonably estimates the base compensation for an individual hired into this position in geographies that require salary range disclosure. The individual may also be eligible for discretionary bonuses.