Customer Service Representative
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AI Summary
Point C is a National third-party administrator (TPA) with local market presence that delivers customized self-funded benefit programs. Our commitment and partnership means thinking beyond the typical solutions in the market – to do more for clients – and take them beyond the standard “Point A to Point B.” We have researched the most effective cost containment strategies and are driving down the cost of plans with innovative solutions such as, network and payment integrity, pharmacy benefits and care management. There are many companies with a mission. We are a mission with a company.
The Customer Service Agent corresponds with callers providing benefit information, claim status, or general health plan information based on the schedule of benefits stated in the plan documents by performing the following duties. Training is conducted remotely and upon successful completion will work remotely. The schedule varies based on business needs but can be performed between the hours of 8:00 am to 8 pm Monday – Friday, Eastern Time zone.
Primary Responsibilities:
- Create a welcoming experience by authentically engaging every caller, every time.
- Make a connection with customers by engaging in friendly and genuine conversation throughout each call to provide a world-class experience.
- Interacting with team and co-workers in a supportive and purpose-drive environment.
- Thoroughly and accurately answer questions about customers’ healthcare accounts.
- Thoughtfully listen to callers’ needs and provide appropriate solutions.
- Demonstrate a culture of ethical conduct, safety, and compliance.
- Handle 35-50+ inbound and outbound phone calls per day.
- Work closely with claim staff to make warranted adjustments to claims.
- Other duties are based on business needs.
Preferred Qualifications:
- Bachelor’s degree or medical billing/coding certification.
- Additional TPA or payer experience.
- 2+ years of customer service experience; 1+ year in TPA or payer setting.
- Strong communication, multitasking, and computer skills (Microsoft Office).
- Ability to work remotely and handle prolonged computer-based tasks.
Individual compensation will be commensurate with the candidate's experience and qualifications. Certain roles may be eligible for additional compensation, including bonuses, and merit increases. Additionally, certain roles have the opportunity to receive sales commissions that are based on the terms of the sales commission plan applicable to the role.
- Comprehensive medical, dental, vision, and life insurance coverage
- 401(k) retirement plan with employer match
- Health Savings Account (HSA) & Flexible Spending Accounts (FSAs)
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Paid time off (PTO) and disability leave
- Employee Assistance Program (EAP)
Equal Employment Opportunity: At Point C Health, we know we are better together. We value, respect, and protect the uniqueness each of us brings. Innovation flourishes by including all voices and makes our business—and our society—stronger. Point C Health is an equal opportunity employer and we are committed to providing equal opportunity in all of our employment practices, including selection, hiring, performance management, promotion, transfer, compensation, benefits, education, training, social, and recreational activities to all persons regardless of race, religious creed, color, national origin, ancestry, physical disability, mental disability, genetic information, pregnancy, marital status, sex, gender, gender identity, gender expression, age, sexual orientation, and military and veteran status, or any other protected status protected by local, state or federal law.
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