• Handle inbound and outbound calls from patients, members, and healthcare providers.
• Provide accurate information regarding insurance coverage, plan benefits, co-pays, deductibles, and eligibility.
• Assist callers with claims status, billing questions, payment arrangements, and explanation of benefits (EOBs).
• Process account updates, documentation requests, and escalations according to policies.
• Coordinate with internal departments to resolve complex issues (claims, authorizations, provider networks, etc.).
• Maintain confidentiality and adhere to HIPAA and company security standards.
• Log interactions clearly and accurately in the customer management system.
• Achieve performance metrics such as call quality, first-call resolution, handle time, and customer satisfaction.
• De-escalate challenging situations with professionalism and empathy.
• Stay updated on healthcare policies, insurance plans, and regulatory requirements.

Job Requirements

• College Graduate
• with or without experience
• HS or SHS Graduate
• with at least 6 months of experience