Title: Customer Service Representative
Location: Fully Remote
Duration: 6-month contract (potential to extend)
Working Hours: 9:00 AM – 5:30 PM EST or 9:30 AM – 6:00 PM EST (30-minute lunch)
Training Schedule: 9:00 AM – 5:30 PM EST (6 Weeks)
Start Date: Tuesday, Sept 8th 2026
Description:

• Customer Service Representatives (CSR's) are the first point of contact for our members and healthcare providers.
• They assist with inquiries, provide information about member eligibility and benefits, as well as resolve any emerging problems that the member and/or provider face with accuracy and efficiency.

Job Responsibilities:

• Answer and manage inbound inquiries regarding health plan benefits and claims, eligibility, medical and other healthcare procedures, billing and payments and other related topics from customers in a prompt, courteous manner. Conduct out-bound and/or return calls to customers as necessary.
• Ask appropriate questions and listen actively to identify specific questions or issues to provide appropriate response and type of assistance the customer needs while documenting relevant information in a clear and concise manner in computer systems.
• Communicate and partner with customers tactfully and empathetically to resolve issues, using clear language translating healthcare-related jargon and complex processes into simple, step-by-step instructions customers can comprehend and act upon.
• Handle and process customer complaints/ grievances while applying appropriate conflict management skills to de-escalate potentially stressful situations.
• Meet the performance goals established for the position in the areas of efficiency, accuracy, quality, member satisfaction and attendance.
• Adhere to all applicable department, organization and/or regulatory policies and procedures.
• Read, comprehend, and verbalize processes and procedures of the organization and of health insurance coverage.
• Accurately document customer interactions and transactions using the company's CRM system.

Required:

• Bilingual in Spanish & English (validated via bilingual assessment upon offer acceptance) is a plus.
• Customer Service Experience: At least 1-2 years of experience in a customer service role, preferably in a healthcare setting.
• Healthcare Knowledge: Familiarity with healthcare and medical terminologies, as well as an understanding of health plan benefits and patient eligibility.
• Call Center Experience: Experience working in a call center environment at least 1 year, managing inbound calls, and handling high call volumes.
• To be successful in this role, you should be customer-focused, detail-oriented and efficient.
• Ability to work in a fast-paced environment and handle multiple tasks simultaneously while maintaining accuracy and attention to detail.
• Customer service skills to create a positive interaction to ensure we are building trust and longevity with our members and providers.
• Empathy and understanding to deal with sensitive health-related issues of our members
• Adherence to healthcare laws and regulations, particularly in relations to patient confidentiality and rights.
• Ability to work regularly scheduled shifts within hours of operation including the training period, where lunches and breaks are scheduled, with the flexibility to adjust daily schedule, and work over-time and/or weekends, as needed.
• This is a work from home position, which requires a quiet, private workspace without noise and distractions, and reliable internet connectivity provided through a wired connection with a minimum of 100 MBPS speed. A mobile, hot spot, or Wi-Fi connection is NOT acceptable.
• Knowledge of managed care, Commercial, Marketplace, Medicaid and/or Medicare programs; knowledge of medical policy benefits and exclusions is a plus.
• You should have excellent communication, interpersonal and negotiation skills.
• Computer Skills: Proficiency in Microsoft Office applications (Word, Excel, Outlook, PowerPoint) is essential.
• Technical Proficiency: Ability to navigate and use multiple computer applications simultaneously, including CRM systems, email platforms, and other relevant software.

About Client:

• Our customer service team offers candidates the opportunity to make a meaningful impact by providing exceptional support to our valued customers, fostering a sense of job satisfaction through problem-solving and positive interactions.
• Our team values collaboration, continuous learning, and a customer-centric approach, ensuring that every team member contributes to providing better health outcomes.
• Leadership rewards and recog