Customer Care Specialist- (Hybrid-Must be base in or near Orlando FL)

Customer Care Specialist (Hybrid – Must be base in or near Orlando, FL) Job Description The Customer Care Specialist is responsible for providing exceptional support to members and providers by addressing inquiries related to eligibility, benefits, claims, and service authorizations. The role involves handling incoming calls, accurately documenting intake information into designated systems, and delivering outstanding customer service to both internal and external stakeholders. The goal is to resolve member and provider needs efficiently, ideally on the first call and consistently meet or exceed established performance standards for quality and productivity. Responsibilities Engage inbound callers professionally; actively listen and probe to determine purpose of the call and resolve administrative concerns, including claims and dissatisfaction. Make outbound calls to solve member issues such as billing issues with a Pharmacy or provide additional information needed for a prior authorization. Research and communicate member information such as eligibility, benefits, Employee Assistance Program (EAP) services, claims, and authorizations while maintaining confidentiality. Initiate care programs by accurately assembling and entering patient data into appropriate systems for EAP, Care, and Utilization Management. Educate providers and members on claims submission, treatment plans, appeal processes, and reimbursement rates across multiple networks. Identify and respond to crisis calls, assisting clinicians until resolution; make routine referrals and triage decisions not requiring clinical judgment. Support continuous improvement by identifying operational inefficiencies, performing follow-up tasks, and ensuring member/provider needs are fully met. Document interactions thoroughly; forward necessary information to appropriate staff and refer provider‑related inquiries to the correct teams. Other duties as assigned. Minimum Qualifications High school diploma from an accredited school or GED. Additional Qualifications Flexible scheduling and comfortable with change. Proficient typist (average 35+ WPM) with strong written and verbal communication skills. Ability to multitask and navigate various computer platforms while verifying information on all calls. Ability to thrive in high‑volume call center environments, managing a large number of inbound and outbound calls efficiently. Familiarity with medical terminology, healthcare procedures, and insurance‑related language to effectively support member and provider inquiries. Knowledge of HIPAA regulations and other healthcare compliance standards. Preferred Qualifications Prior experience in a healthcare or insurance call center environment. Previous customer service experience. Previous experience with Genesys and CRM technology platforms. Every employee must understand, comply with and attest to the security responsibilities and security controls unique to their job, and comply with all applicable legal, regulatory, and contractual requirements and internal policies and procedures. Every employee must be able to perform the essential functions of the job and, if requested, reasonable accommodations will be made to enable employees with disabilities to perform the essential functions absent undue hardship. In addition, Prime retains the right to change or assign other duties to this job. Potential pay for this position ranges from $17.85 - $25.48 based on experience and skills. Prime Therapeutics LLC is a proud equal opportunity and affirmative action employer. We encourage diverse candidates to apply; all qualified applicants will receive consideration for employment without regard to race, color, religion, gender, sex (including pregnancy), national origin, disability, age, veteran status or any other legally protected class under federal, state, or local law. We welcome people of different backgrounds, experiences, abilities, and perspectives, including qualified applicants with arrest and conviction records and any qualified applicants requiring reasonable accommodations in accordance with the law. Prime Therapeutics LLC is a Tobacco‑Free Workplace employer. For applicants with a disability who need reasonable accommodation for any part of the employment process, please contact Human Resources at View email address on click.appcast.io. #J-18808-Ljbffr Prime Therapeutics