Handle inbound calls regarding healthcare enrollment, eligibility, and account information while maintaining accurate member records. Research inquiries using client systems and ensure all actions comply with HIPAA and privacy regulations.
The Customer Service Representative acts as the primary point of contact for clients, providing technical and product assistance via phone, email, or chat. They are responsible for troubleshooting issues, documenting interactions in Salesforce, and ensuring client satisfaction through timely and professional support.
The role involves reviewing, investigating, and adjudicating medical claims and provider disputes in accordance with payer guidelines and regulatory requirements. Examiners must maintain accurate records, collaborate with internal stakeholders, and ensure productivity and quality standards are met.
The role involves delivering financial and operational analysis, reporting, and forecasting to support informed decision-making by leadership. It also requires developing dashboards and leveraging data analytics to improve processes and identify performance trends.
