Job Description
Are you passionate about helping others and making a difference in the healthcare industry? We're looking for a Healthcare Customer Service Representative II to join our team! In this role, you'll provide exceptional service to members by assisting with policy management, benefits inquiries, and claims support—all from the comfort of your home.
This is a full-time, 100% remote position with a Monday-Friday schedule (9:00 AM - 9:00 PM EST, shifting schedule).
Why You'll Love This Role:
✅ Work from home with a competitive benefits package
✅ Paid training to set you up for success
✅ Opportunity to grow in a supportive, team-oriented environment
What You'll Do:
Policy Management:
Billing Support - Process member payments, address billing inquiries, and resolve discrepancies.
Account Updates - Accurately update member details, including addresses, phone numbers, beneficiaries, and employment information.
Policy Changes - Assist with policy terminations, reinstatements, and ID card requests.
Benefits Assistance:
Coverage Information - Provide clear and accurate details on eligibility, benefits, limitations, and exclusions.
Authorizations & Referrals - Guide members through prior authorization and referral procedures.
Provider Research - Help locate healthcare provider contact information for members.
Claims Support:
Status Updates - Inform members about the progress of their claims and address concerns.
Claims Inquiries - Explain claim processing, denials, and appeal procedures.
Claims Reconsideration - Assist members with submitting reconsideration requests and gathering documentation.
General Member Support:
Website Assistance - Help members troubleshoot and navigate the online portal.
Answer General Inquiries - Respond to questions regarding health plans, policies, and procedures.
Escalations & Confidentiality - Escalate complex issues when necessary and always maintain confidentiality.
What We're Looking For:
Excellent communication skills (both written and verbal)
Strong customer service experience, preferably in healthcare or insurance
Attention to detail and ability to multi-task
Tech-savvy with experience in data entry and screen navigation
Knowledge of healthcare terminology (ICD-9, ICD-10 coding, policy process flows)
Ability to work independently and as part of a team
Strong problem-solving and time-management skills
What You Need to Qualify:
High School Diploma or GED (required)
At least 2 years of experience in healthcare customer service, claims processing, medical office administration, or a related field
Ability to pass a background check
Work-From-Home Requirements:
Reliable high-speed internet (minimum 25 Mbps download, 5 Mbps upload)
Ability to hardwire directly to your modem for a stable connection
A quiet, dedicated workspace free from distractions
What We Offer:
Paid training to ensure your success
Comprehensive benefits package, including medical, dental, vision, life insurance, HSA, and 401(k)
Paid time off (PTO) to support work-life balance
Employment Type: Full-Time
Salary: $ 17.00 19.00 Per Hour
Job Tags
Hourly pay, Full time, Remote job, Work from home, Shift work, Monday to Friday,