Representative, Support Center III - Remote

1. About Our Client:The organization operates within the health insurance sector, focusing on Medicaid, Medicare, and Marketplace lines of business. It addresses challenges related to member and provider engagement by delivering multi-channel customer support and facilitating quality improvement initiatives that enhance service experiences and retention.2. About the Opportunity:The Representative, Support Center III provides advanced customer service support to members and providers across multiple states and product lines. This role is crucial for resolving complex issues, improving member and provider relationships, and contributing to continuous quality improvements in customer engagement.3. Responsibilities:• Deliver service support via phone, chat, email, and administrative duties for Medicaid, Medicare, and Marketplace customers.• Address member and provider issues including appeals, grievances, problem resolution, and material development.• Provide product and service information to maintain and enhance relationships.• Manage escalated calls on behalf of leadership.• Accurately document all communications.• Adhere to scheduled shifts and protocols, including overtime and weekend coverage as needed.• Build rapport with customers, responding with compassion and exceeding expectations.• Listen attentively to identify customer needs and requests.• Meet individual performance goals for call quality, attendance, and adherence.• Take ownership of customer issues, ensuring timely resolution.• Support inquiries related to eligibility, benefits, claims, authorizations, and credentialing.• Conduct initial research and escalate issues appropriately.• Handle complex provider inquiries and demonstrate understanding of service-related issues.• Evaluate options and develop solutions by analyzing root causes.• Demonstrate proficiency in multiple lines of business.• Complete research for regulatory inquiries as applicable.• Conduct member satisfaction assessments and surveys.• Assist retention and inbound functions as required.• Communicate professionally and collaborate across departments.• Train and support new and existing support center representatives.4. Requirements:• Minimum 2 years’ experience in customer service, call center, or sales in a high-volume environment, or equivalent education and experience.• Knowledge of Medicaid, Medicare, and Marketplace insurance products and enrollment processes.• Strong customer service skills and ability to conduct research while maintaining communication.• Experience in data processing.• Attention to detail, organizational skills, and ability to manage multiple tasks.• Ability to maintain confidentiality and comply with HIPAA regulations.• Ability to foster positive working relationships with coworkers, members, providers, and customers.• Effective verbal and written communication skills.• Proficiency with Microsoft Office and relevant software.Preferred Qualifications:• Experience with systems such as Microsoft Teams, Genesys, Salesforce, Pega, QNXT, CRM, Verint, CVS Caremark, Availity.• Call center and managed care or health care experience.• Broker or health insurance license.5. Pay Range and Compensation Package:• The pay range and compensation package for this role will be determined based on the candidate’s experience, skills, and other relevant factors.Equal Opportunity Statement: Our client is an equal opportunity employer. They celebrate diversity and are committed to creating an inclusive environment for all employees. All qualified applicants will receive consideration for employment without regard to race, color, religion, gender, gender identity or expression, sexual orientation, or national origin.Note:RemoteHunter is not the Employer of Record (EOR) for this role. Our purpose in this opportunity is to connect exceptional candidates with leading employers. We help job seekers worldwide discover roles that match their goals and guide them to complete their full application directly through the hiring company’s career page or ATS.