Job Description

Role Overview

As an Inbound Customer Care Representative at Healthplan Services Inc, you will be the first point of contact for our clients and members seeking support with their health, dental, and vision insurance claims. Your role is essential in delivering an exceptional customer service experience by actively listening, asking relevant questions, and carefully assessing each individual's needs to provide timely and accurate assistance. This position requires a professional and empathetic approach, as you will be managing a variety of account requests and inquiries within a fast-paced environment.

Working alongside a dedicated team, you will contribute to the seamless administration of third-party health insurance claims, ensuring compliance with established procedures and carrier policies. You will utilize your organizational and prioritization skills to handle multiple tasks efficiently, all while maintaining a warm and courteous telephone demeanor.

Key responsibilities include:

• Adhering to claims processing guidelines and benefit structures to ensure accurate handling of member requests.
• Effectively managing problem escalations by coordinating with appropriate departments and following up until resolution.
• Maintaining detailed and accurate documentation of all customer interactions and account information in the system.
• Meeting established production and quality standards consistently.
• Demonstrating a strong ability to address inquiries with patience, professionalism, and clarity.

The ideal candidate will have a high school diploma or GED equivalent and bring a customer-centric mindset, strong problem-solving abilities, and clear communication skills. Experience in a customer service role within the insurance or healthcare sectors is advantageous but not mandatory. We welcome applicants who are adaptable, self-motivated, and eager to contribute positively to a collaborative team environment.

Join us in making a real difference for our customers by providing reliable and respectful assistance that supports their health and wellbeing needs.

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Performance Expectations and Deliverables

Success in these areas directly influences our ability to provide superior support and develop innovative solutions that benefit both our customers and the organization. Regular feedback from project managers and participation in continuous learning initiatives will support your professional growth and effectiveness in the role.