Call Center Representative

Job Summary

The Participant Advocate provides phone and customer service support to individuals with healthcare and benefits-related questions. This role requires strong communication skills, empathy, attention to detail, and the ability to research and resolve customer concerns. Training will be provided on specific benefits and systems.

Responsibilities

• Handle inbound calls and respond to customer questions regarding healthcare benefits, eligibility, claims, and payments.
• Research customer issues and provide accurate information and solutions.
• Explain claim details, payments, and denials in a clear and easy-to-understand manner.
• Verify eligibility and benefit information and assist with updates when needed.
• Work with healthcare providers, vendors, employers, and internal teams to resolve customer issues.
• Assist customers with forms, enrollment, claims, and other healthcare-related processes.
• Help customers navigate online resources and benefit information.
• Document all customer interactions accurately and maintain detailed records.
• Identify and escalate complex issues when additional assistance is required.
• Maintain a professional, patient, and empathetic approach when handling sensitive or difficult situations.
• Participate in team projects and provide support to other departments as needed.

Qualifications

• 1+ year of call center experience in a medical, healthcare, insurance, or related environment required.
• High School Diploma required.
• Experience handling high-volume inbound calls preferred.
• Strong verbal and written communication skills.
• Excellent customer service and problem-solving abilities.
• Strong attention to detail and ability to maintain accurate records.
• Ability to research issues and explain information clearly.
• Proficiency with Microsoft Office.
• Dependable, professional, and comfortable working in a team environment.
• Ability to remain calm, patient, and positive when handling challenging customer situations.
• Willingness to learn new healthcare benefits, systems, and processes.

Schedule

• Full-time, in-office position
• Monday through Friday
• 40 hours per week
• Standard business hours, with potential for a later shift