Customer Service Representative

Job Description

You will handle inbound calls and messages from providers, members, and health plans to deliver timely, empathetic support and aim for first‑call resolution. Using Access Express and other internal tools, you’ll interpret claim information and explain findings to callers; when deeper detail is required you will navigate legacy systems (AS/400) or escalate to Claims/UM as appropriate. New hires receive three days onsite for equipment pickup and onboarding, then work remotely with ongoing shadowing and coaching.

Typical daily activities include:

• Answering inbound provider and member calls/messages via Access Express and phone

• Reviewing claim status and denial reasons; explaining CPT codes and denial rationale to callers

• Using reference guides and internal systems to determine next steps or escalation path

• Documenting call notes, actions taken, and follow‑up items in the system

• Routing or escalating complex issues to Claims, Utilization Management, or Leadership

• Participating in remote coaching, quality reviews, and team huddles

• Assisting with basic authorization and inquiry triage submitted through provider portals

We are a company committed to creating diverse and inclusive environments where people can bring their full, authentic selves to work every day. We are an equal opportunity/affirmative action employer that believes everyone matters. Qualified candidates will receive consideration for employment regardless of their race, color, ethnicity, religion, sex (including pregnancy), sexual orientation, gender identity and expression, marital status, national origin, ancestry, genetic factors, age, disability, protected veteran status, military or uniformed service member status, or any other status or characteristic protected by applicable laws, regulations, and ordinances. If you need assistance and/or a reasonable accommodation due to a disability during the application or recruiting process, please send a request to View email address on click.appcast.io learn more about how we collect, keep, and process your private information, please review Insight Global's Workforce Privacy Policy:

Skills and Requirements

• 2+ years of experience as a customer service representative, member services representative, or a patient services representative

• 1+ years of experience in a healthcare or medical environment • Prior experience with provider portals (e.g., Access Express) or claims adjudication tools

• Experience with legacy systems such as AS/400

• Background in authorizations, utilization management, or provider credentialing