Customer Service Representative
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Job Description
Customer Service Representative assisting members with health insurance inquiries and claims. Handling support via phone, email, and chat while ensuring HIPAA compliance.
Responsibilities:
- Provide guidance on provider networks, referrals and pre-authorizations.
- Troubleshoot and resolve issues related to billing, payments and coverage.
- Ensure compliance with HIPAA regulations when handling sensitive member information.
- Collaborate with internal departments to resolve complex member concerns.
- Maintain accurate records of customer interactions and resolutions in CRM systems.
- Meet performance metrics such as response time, resolution rate and customer satisfaction scores.
- Stay updated on policies, state regulations and healthcare industry changes.
Requirements:
- Previous customer service experience, preferably in healthcare or insurance.
- Strong verbal and written communication skills.
- Independent decision-making and problem-solving skills with the ability to remain calm under pressure.
- Ability to handle high call/chat/email volumes effectively.
- Proficiency in computer applications, including CRM and customer support platforms.
- Ability to work flexible shifts, including weekends and holidays.
- Must be 18 years or older
- High school diploma or equivalent
- Must reside in the state of New Mexico
Benefits:
- Paid training
- A culture that celebrates YOU
- Opportunities for growth and advancement
- A team that’s got your back
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