Customer Care Center Rep

Overview TheCustomerCare Center Rep plays a critical role delivering exceptional service to our members, brokers, and providers. The role provides detailed responses to health plan inquiries and resolves issues with compassion and efficiency. The Customer Care Center Rep is the first point of contact for those seeking assistance with benefits, eligibility, and claims questions. Success is accomplished by navigating multiple systems to research and resolve inquiries with a clear, accurate, and easy to understand response. Responsibilities Serve as the first point of contact for members, brokers, and medical providers, answering inquiries regarding benefits, eligibility, claims, billing, and healthcare services. Assist members in understanding their benefits, eligibility, claim status and the resolution of billing issues. Respond to provider inquiries related to claims, authorizations, and reimbursement status. Address and resolve service requests, complaints and issues efficiently, ensuring high levels of customer satisfaction. Collaborate with internal teams to address complex inquiries and facilitate a seamless experience. Review detailed information across multiple systems to accurately resolve inquiries while delivering clear, professional, and thorough responses (both written, and verbal), that are easy to understand by a diverse population. Accurately document all interactions in the system, ensuring thorough record‑keeping for follow‑up actions and quality assurance purposes. Develop a thorough understanding of health plan products and services, actively learning updates to policies, procedures, and regulatory requirements. Ensure adherence to regulatory guidelines (i.e., HIPAA, CMS) when providing information and service to members, providers or brokers. Other job‑related responsibilities may be assigned as required. Minimum Qualifications High School Diploma or GED or equivalent experience. One (1) or more years of customer service experience in a fast paced, high‑volume health insurance or healthcare call center environment. Strong verbal and written communication skills with the ability to effectively explain complex information. Demonstrated problem‑solving skills with the ability to handle difficult situations with empathy and patience. Solid ability to multitask, prioritize, and manage time effectively in a fast‑paced environment. Ability to maintain a high level of accuracy and attention to detail. Proficiency in Microsoft Office Suite and website and/or portal navigation. Ability to adhere to a structured work schedule based around the central time zone. Preferred Qualifications Familiarity with customer service software such as Facets or NTT. Basic knowledge and understanding of medical terminology. Remote Work Requirements High speed cable or fiber. Minimum of 10 Mbps downstream and at least 1 Mbps upstream internet connection (can be checked at ). Performance bonus and/or merit increase opportunities. 401(k) with a 100% match for the first 3% of your salary and a 50% match for the next 2% of your salary (100% vested immediately) . Competitive paid time off. Health insurance, dental insurance, and telehealth services start DAY 1 . Professional and Leadership Development Programs. Equal Opportunity Employer Equal Opportunity Employer/Protected Veterans/Individuals with Disabilities This employer is required to notify all applicants of their rights pursuant to federal employment laws. For further information, please review the Know Your Rights notice from the Department of Labor. #J-18808-Ljbffr WPS Health Solutions