Responsibilities

• Act as the first point of contact for members, patients, beneficiaries, or providers, handling inquiries about healthcare benefits, coverage, claims, billing, eligibility, and account issues.
• Respond to inbound calls (and sometimes outbound calls) professionally and courteously, delivering clear, accurate information and support.
• Educate customers about their healthcare plan, benefits, cost-sharing, prescription coverage, and how their plan works.
• Research and help resolve premium billing discrepancies, claim status issues, or questions about coverage.
• Update and maintain accurate member account information, including contact details, billing preferences, and eligibility changes, in internal systems.
• Document detailed notes for each interaction to maintain complete records of customer communication, inquiries, resolutions, and follow-ups.
• Escalate unresolved or complex issues to supervisors or appropriate departments when needed.

Job Requirements

• HS Graduate or College Graduate
• With or without experience
• Strong communication skills