Health Insurance Advocate

Job Description

Job Description

Why You Want To Work Here

Are you a people-focused customer service professional who enjoys helping others, solving problems, and making complicated information easier to understand? We’re looking for a Call Center Representative. In this role, you’ll serve as a trusted resource for participants navigating their health benefits, answering questions, resolving concerns, and helping people understand the processes and resources available to them.

This is more than a traditional customer service position. You’ll have the opportunity to build expertise in health benefits and insurance while developing strong communication, problem-solving, and client-service skills. Comprehensive training and support will be provided—you don’t need to be a benefits expert on day one.

Responsibilities

• Provide friendly, professional, and empathetic customer service by phone, email, in person, and through written correspondence
• Handle a high volume of participant calls while maintaining accuracy, professionalism, and a positive attitude
• Answer questions regarding eligibility, health benefits, claims, self-payments, and other plan-related matters
• Research participant questions and concerns to identify accurate answers and effective solutions
• Explain claim payments and help participants understand why a claim may have been denied
• Verify participant eligibility and benefits and coordinate updates with outside vendors
• Collaborate with internal departments, healthcare providers, vendors, local unions, and employers to resolve participant concerns
• Learn and apply organizational policies, benefit schedules, eligibility systems, claims systems, and other plan resources
• Accurately document participant interactions and maintain complete and organized records
• Assist participants with enrollment forms, working spouse forms, disability claims, special fund claims, and other benefit-related processes
• Help participants navigate the website and online resources
• Escalate complex questions or concerns to the appropriate team member when additional assistance is needed
• Monitor and follow established procedures to ensure accurate and compliant handling of participant requests
• Participate in special projects and provide support to the Customer Service team as needed

Qualifications

• At least 1 year of phone-based customer service experience required; experience as a Customer Service Representative, Receptionist, Scheduler, Patient Care Coordinator, Claims Representative, or similar role is highly relevant
• Previous experience in healthcare, health insurance, benefits administration, or a medical environment is strongly preferred
• High School Diploma or equivalent required; college coursework or a degree is a plus
• Ability to type at least 40 words per minute
• Strong written and verbal communication skills with the ability to explain information clearly and professionally
• Excellent customer service skills and a genuine desire to help others
• Strong attention to detail and accuracy, particularly when working with participant information and benefits-related documentation
• Comfortable handling a high volume of phone calls and working in a structured, rules-oriented environment
• Strong problem-solving and investigative skills with the ability to research issues and identify appropriate solutions
• Ability to remain patient, professional, and empathetic when interacting with frustrated or upset participants
• Strong organizational skills with the ability to manage multiple tasks and priorities
• Proficiency with Microsoft Office and general computer systems
• Ability to work independently while also collaborating effectively with a team
• Dependable and punctual, with a strong commitment to consistent attendance and being prepared to start work on time
• Comfortable working 100% on-site in Rockville, MD
• Willingness to work a potential schedule of 10:00 AM–7:00 PM
• Bilingual skills are a plus