Customer Service Representative (Work at Home)

Virtual Staffing Solutions

This job is closed: the employer no longer lists it.

Skills

Deliver high-quality member and provider support by resolving service inquiries, addressing retention concerns, educating stakeholders on plan benefits, and achieving first-call resolution whenever possible.
Manage customer service requests through telephonic intake, independently resolving non-clinical issues, escalating clinical concerns appropriately, and ensuring timely follow-up and service delivery.
Maintain accurate documentation and data management by recording call details, processing requests, reconciling information across systems, and supporting compliance and reporting requirements.
Serve as a trusted resource for members, providers, and internal teams by explaining benefit coverage, service processes, appeals, and troubleshooting issues while fostering strong customer-focused relationships.
Uphold regulatory and performance standards by protecting confidentiality, complying with federal and state requirements, demonstrating empathy and effective communication, meeting contact center metrics, and contributing to continuous process improvement.

At least 1 year of customer service experience, preferably in a healthcare, health plan, or related environment.
Strong verbal communication, active listening, and customer service skills with the ability to build rapport and resolve concerns effectively.
Military Spouse Employment Partnership (MSEP) candidates are encouraged to apply and will be given priority consideration.
Company-issued PC provided; candidates must have a dedicated, professional workspace for remote work.