We are seeking a skilled and customer-oriented Customer Support Representative with experience in HMO/healthcare claims. The role involves handling voice calls, assisting members with their healthcare benefits, and resolving claims-related concerns while delivering excellent customer service.
Position Responsibilities
- Handle inbound and outbound calls related to HMO inquiries and claims
- Assist members with benefit verification, eligibility, and claims status
- Explain coverage, policies, and procedures clearly and accurately
- Resolve customer concerns regarding claims processing, billing, and reimbursements
- Escalate complex or unresolved issues to the appropriate department
- Accurately document call details and transactions in the system
- Ensure compliance with company policies and healthcare regulations
- Maintain high-quality service standards and meet performance metrics
Position Requirements
- At least a High School Diploma or equivalent (College level/graduate preferred)
- Minimum of 1–2 years experience in customer support, preferably in HMO or healthcare accounts
- Strong understanding of HMO processes, claims handling, and member services
- Excellent verbal communication skills is a must
- Ability to explain complex healthcare information in a simple and clear manner
- Good problem-solving and multitasking abilities
- Basic computer and CRM system knowledge
- Advanced English proficiency for both spoken and written is a must.
