Customer Service Rep I

Job Description

Job Description

Customer Service Representative I

Role Insights

The Customer Service Representative I plays a critical role within the organization, serving as a central point of communication between clients, members, and internal departments. This position operates in a high-volume call center environment, requiring the ability to efficiently manage a steady flow of incoming calls while addressing a wide range of inquiries, including claims, service authorizations, and other service-related concerns.

This is a dynamic, fast-paced role that demands energy, professionalism, compassion, empathy and a strong commitment to delivering exceptional, service-focused experiences. Success in this position requires confidence in problem-solving, sound judgment, and the ability to resolve issues promptly and effectively. In addition to handling inbound calls, representatives are responsible for conducting timely follow-up outreach to ensure issues are fully resolved. Strong time management and organizational skills are essential to balance call volume with follow-up responsibilities throughout the day.

Performance in this role is measured through key performance indicators (KPIs), including call metrics, first-call resolution effectiveness, escalation rates, and overall service quality.

Primary Responsibilities

• Manage a high volume of routine inbound calls from members, brokers, healthcare providers, and health plans, addressing inquiries related to claim status, eligibility, service authorizations, benefits, case management, etc. 
• Verify and communicate member eligibility and benefits, and provide accurate, timely information regarding access to services 
• Deliver claim status updates, complete check tracers, guide callers to the portal when appropriate and resolve routine inquiries during the initial call whenever possible 
• Research, analyze, and resolve issues related to claims, eligibility, case management, authorizations or any other customer related request, ensuring thorough and timely resolution 
• Conduct outbound follow-up calls, taking full ownership to ensure completion and resolution of outstanding issues 
• Escalate complex or unresolved issues to senior representatives (CSR II/III) or the appropriate department as needed
• Accurately document all interactions, actions taken, and outcomes within CRM/EHR and proprietary systems 
• Monitor for trends in call types (disposition) or issues and proactively communicate observations to management 
• Meet or exceed established performance metrics, including call metrics, quality standards, and first-call resolution 
• Perform additional duties as assigned

Required Skills and Abilities

• High school diploma or GED required; Associate degree or higher preferred 

• Minimum of 2 years of call center or customer service experience strongly preferred 
• At least 1 year of experience in a healthcare or medical environment preferred; working knowledge of managed care concepts (e.g., HMO, IPA structures) and HIPAA compliance requirements 
• Strong verbal and written communication skills with the ability to convey information clearly and professionally 
• Positive, professional attitude with strong interpersonal and customer service skills that include but are not limited to active listening, demonstrating empathy, upbeat tone and presence (let the caller hear your smile), professional call control, appropriate use of probing questions, reflecting understanding of request, and strong cultural sensitivity and awareness 
• Demonstrates critical thinking and problem-solving skills with the ability to assess situations and deliver timely, effective solutions 
• Excellent time management and organizational skills in a fast-paced, high-volume environment 
• Ability to follow scripts, standard workflows, and established procedures while maintaining service quality 
• Self-motivated with a strong work ethic and results-driven mindset 
• Proficiency in Microsoft Office applications and CRM/EHR systems 
• Strong data entry skills with a high level of accuracy and attention to detail 
• Reliable and consistent attendance with the ability to work a standard schedule (i.e. Monday–Friday, 8:00 AM – 5:00 PM)

Decision-Making & Scope of Authority

• Resolves routine inquiries and standard customer issues independently with kindness, compassion and empathy
• Exercises basic to moderate decision-making authority within established guidelines, scripts, and standard workflows 
• Follows established procedures and uses sound judgment to ensure compliance with organizational policies and regulatory requirements 
• Seeks guidance when needed to ensure accurate and complete resolution of customer concerns
• Appropriately escalates complex, non-routine, or unresolved issues to CSR II/III or leadership as appropriate 

AMM BENEFITS

When you join AMM, you’re not just getting a job—you’re getting a benefits package that puts YOU first:

• Health Coverage You Can Count On : Full employer-paid HMO and the option for a flexible PPO plan .
• Wellness Made Affordable : Discounted vision and dental premiums to help keep you healthy from head to toe.
• Smart Spending : FSAs to manage healthcare and dependent care costs, plus a 401(k) to secure your future.
• Work-Life Balance : Generous PTO , 40 hours of sick pay , and 13 paid holidays to enjoy life outside of work.
• Career Development : Tuition reimbursement to support your education and growth.
• Team Fun : Paid company outings and lunches because we work hard, but we also know how to have fun!