Overview: We are seeking a dedicated Healthcare Customer Service Representative to join our team. This role involves assisting members with inquiries related to their insurance plans, eligibility, benefits, and claims. The ideal candidate will have a strong understanding of various insurance plan types and excellent communication skills.
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 HR@insightglobal.com.
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Key Responsibilities:
Healthcare Basics
Recognize and understand various insurance plan types, including Commercial, Individual Products, HIX, and Government Plans (Medicaid/Medicare).
Familiarity with common insurance terminology and procedures.
Phone Skills
Receive and respond to member inquiries via inbound calls using NICE inContact - Max Agent.
Make outbound calls to members, vendors, and other departments.
Follow established call flow processes for member interactions.
Understand and apply protocols for using the language line for effective communication.
Eligibility and Enrollment
Verify member status, including ID numbers and personal information, using Salesforce, CSC, and QNXT.
Confirm member eligibility and plan effective dates.
Manage member correspondence, including sending plan documents and updating demographics.
Benefit packages for this role will start on the 31st day of employment and include medical, dental, and vision insurance, as well as HSA, FSA, and DCFSA account options, and 401k retirement account access with employer matching. Employees in this role are also entitled to paid sick leave and/or other paid time off as provided by applicable law.