Call Center Customer Service Representative

Job DescriptionThe Customer Service Representative (CSR) will be responsible for handling inbound calls, chats, and secure messages from healthcare providers or their authorized representatives. The CSR will assist with inquiries related to benefits, eligibility, claims, authorizations, and other support services. This position requires the ability to work across various systems, deliver exceptional customer service, and ensure compliance with privacy and regulatory standards including HIPAA and other applicable guidelines.Key ResponsibilityRespond To Provider Inquiries Related ToBenefits, eligibility, and claim statusClaim research and Explanation of Benefits (EOB)Authorizations and provider directory inquiriesNavigation support and promotion of the provider self-service portalUtilize internal systems and tools (via secure access methods) to retrieve and update information.Document all interactions accurately in the designated call/chat tracking systems.Escalate unresolved cases to the appropriate internal departments.Complete all post-interaction tasks, including memos and detailed notes.Communicate clearly, concisely, and professionally with healthcare providers.Promote the effective use of self-service tools and digital resources.Adhere to all privacy laws and regulatory compliance requirements.Meet performance targets and service level agreements (SLAs).Required QualificationHigh school diploma or equivalent (mandatory)Some college education or a completed degree (preferred)Strong command of the English language (verbal and written)Basic knowledge of Windows OS and Microsoft Office toolsRequired Experience1–2 years of customer service experience (preferably in healthcare or insurance)Experience working in a call center or support environmentFamiliarity with claims processing systems and provider portals (preferred)Behavioral AttributesEmpathy: Understands and acknowledges provider concernsProfessionalism: Maintains a calm and respectful tone under pressureAccountability: Takes ownership of responsibilities and outcomesAdaptability: Flexible with process changes and system updatesConfidentiality: Complies with data privacy standards and regulationsCompetenciesExcellent Communication: Ability to articulate clearly and listen activelyProblem Solving: Uses logic and reasoning to resolve issues effectivelyTechnical Proficiency: Comfortable navigating multiple systems and platformsTime Management: Handles tasks efficiently while meeting deadlinesCustomer Centricity: Focused on delivering a positive provider experienceTeam Collaboration: Works well with others and contributes to team successQualificationsGraduateRange Of Year Experience-Min Year2Range Of Year Experience-Max Year4