Healthcare Customer Service Representative - i3 Verticals : Job Details

JOB TITLE: Healthcare Customer Service RepresentativeFLSA STATUS: Non-ExemptDEPARTMENT: HealthcareREPORTS TO: VariesSUPERVISORY RESPONSIBILITIES: NoJOB LOCATION:TRAVEL: NoESSENTIAL DUTIES & RESPONSIBILITIES:* Provide Expert Customer Service: Respond to incoming calls from patients, insurance members, and healthcare providers, offering clear, accurate information on health care services, benefits, claims, and medical procedures.* Address and Resolve Inquiries: Manage inquiries related to insurance coverage, medical claims, and patient services. Identify and resolve issues or escalate to higher-level staff when necessary.* Documentation & Data Entry: Maintain accurate and up-to-date records of calls, services, and patient/member interactions in electronic systems, adhering to data privacy regulations.* Claims & Billing Support: Assist members and patients in understanding claims status, benefits coverage, and insurance-related billing questions.* Collaborate Across Departments: Work closely with other teams (e.g., billing, medical records, and insurance) to address complex issues and ensure resolution in a timely manner.* Ensure Compliance with HIPAA: Handle patient and member information confidentially, following all regulatory requirements under HIPAA.* Monitor Service Levels: Meet or exceed service-level expectations, including answering calls within set times and resolving issues promptly.* Customer Education: Educate patients or members on further communication.* Provide Feedback: Collect feedback from customers and relay insights to management on common issues or service improvement opportunities.* Client Focus: Understanding of client organizational structure and ability to apply client specific guidelines to patient inquiries.MINIMUM QUALIFICATIONS (EDUCATION AND EXPERIENCE):* High School Diploma or equivalent.* Communication Skills: Strong verbal communication skills with the ability to convey complex information clearly and empathetically.* Technical Proficiency: Comfortable with computer systems, databases, and phone systems.* Problem-Solving Skills: Ability to handle inquiries and resolve issues promptly and effectively, with attention to detail.* Confidentiality: Understanding of confidentiality and data privacy practices, particularly HIPAA regulations.PREFERRED QUALIFICATIONS (EDUCATION AND EXPERIENCE):* Experience in Customer Service: At least one year of experience in a customer service role, ideally within a health care, insurance, or medical setting.* Advanced Education: Associate's degree or relevant certifications.* Knowledge of Health Insurance Plans: Experience with different types of insurance coverage, such as HMO, PPO, Medicaid, Medicare, or private plans.* Bilingual: Proficiency in a second language (e.g., Spanish) is preferred to assist with a diverse patient and member base.* Familiarity with KPIs & Performance Metrics: Experience in meeting customer service metrics, including call response times, resolution rates, and customer satisfaction scores.Physical Demands and Work Environment:The physical demands described here are representative of those that must be met by an employee to successfully perform the essential functions of this position. Reasonable accommodations may be made to enable individuals with disabilities to perform these functions.While performing the duties of this position, the employee is regularly required to talk or hear. The employee frequently is required to use hands or fingers, handle or feel objects, tools, or controls. The employee is occasionally required to stand; walk; sit; and reach with hands and arms. The employee must occasionally lift and/or move up to 25 pounds. Specific vision abilities required by this position include close vision, distance vision, and the ability to adjust focus. The noise level in the work environment is usually low to moderate.This job description is not designed to cover or contain a comprehensive listing of activities, duties or responsibilities that are required of the employee. Duties, responsibilities and activities may change, or new ones may be assigned at any time with or without notice.