Call Center Customer Service Representative

Job Description The Customer Service Representative (CSR) will be responsible for handling inbound calls, chats, and secure messages from healthcare providers or their authorized representatives. The CSR will assist with inquiries related to benefits, eligibility, claims, authorizations, and other support services. This position requires the ability to work across various systems, deliver exceptional customer service, and ensure compliance with privacy and regulatory standards including HIPAA and other applicable guidelines. Job Description The Customer Service Representative (CSR) will be responsible for handling inbound calls, chats, and secure messages from healthcare providers or their authorized representatives. The CSR will assist with inquiries related to benefits, eligibility, claims, authorizations, and other support services. This position requires the ability to work across various systems, deliver exceptional customer service, and ensure compliance with privacy and regulatory standards including HIPAA and other applicable guidelines. Key Responsibility Benefits, eligibility, and claim status Claim research and Explanation of Benefits (EOB) Authorizations and provider directory inquiries Navigation support and promotion of the provider self-service portal Utilize internal systems and tools (via secure access methods) to retrieve and update information. Document all interactions accurately in the designated call/chat tracking systems. Escalate unresolved cases to the appropriate internal departments. Complete all post-interaction tasks, including memos and detailed notes. Communicate clearly, concisely, and professionally with healthcare providers. Promote the effective use of self-service tools and digital resources. Adhere to all privacy laws and regulatory compliance requirements. Meet performance targets and service level agreements (SLAs). Required Qualification High school diploma or equivalent (mandatory) Some college education or a completed degree (preferred) Strong command of the English language (verbal and written) Basic knowledge of Windows OS and Microsoft Office tools Required Experience 1-2 years of customer service experience (preferably in healthcare or insurance) Experience working in a call center or support environment Familiarity with claims processing systems and provider portals (preferred) Behavioral Attributes Empathy: Understands and acknowledges provider concerns Professionalism: Maintains a calm and respectful tone under pressure Accountability: Takes ownership of responsibilities and outcomes Adaptability: Flexible with process changes and system updates Confidentiality: Complies with data privacy standards and regulations Competencies Excellent Communication: Ability to articulate clearly and listen actively Problem Solving: Uses logic and reasoning to resolve issues effectively Technical Proficiency: Comfortable navigating multiple systems and platforms Time Management: Handles tasks efficiently while meeting deadlines Customer Centricity: Focused on delivering a positive provider experience Team Collaboration: Works well with others and contributes to team success Qualifications Graduate Range Of Year Experience-Min Year 2 Range Of Year Experience-Max Year 4 #J-18808-Ljbffr Infinite Computer Solutions