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Remote Healthcare Call Center Representative

New York City, NY · Healthcare
Customer Service Representative - Managed Care
Remote, NY
*** This is a Full-Time, Benefits Available, CONTRACT position expected to last 6 months or longer! ***
**MUST reside in NY, RI, or FL**

Customer Service Representative Job Summary:
  • Addresses member inquiries, questions and concerns in all areas including enrollment, claims, benefit interpretation, and referrals/authorizations for medical care.
  • Verify member eligibility, claim and authorization status for providers.
  • Responsible for thorough follow-up and completion of all member, and provider inquires or requests
  • Responsible for accurate, complete and correct documentation into Facets regarding all issues, and/or inquires, complaints and grievances
  • Function efficiently and productively in a high-volume telephone call center.
  • Maintain departmental productivity and quality standards.
  • Provide follow-up assistance as needed
  • Route escalated calls to the appropriate Member Liaison, Supervisor or Call Center Manager
  • Refer issues to health networks and/or make recommendations for further contacts 
  • If designated, responsible for processing all member transportation request within 1 business day of receipt and coordinating all aspects of the process with clinic, provider and member as appropriate or necessary

Customer Service Representative Background: 
  • Requires an education level of at least a high school diploma or GED.
  • Around 1 year customer service experience with at least 6 months experience in an office setting, call center setting, or phone support role.
  • Healthcare experience is required, including basic familiarity with medical terminology.
  • Ability to multi-task duties as well as the ability to understand multiple products and multiple levels of benefits within each product.
  • Knowledge of health care delivery system, Medicaid/Medicare and related state programs is a significant plus.
  • Computer skills to include Microsoft Word, Excel and basic data entry, including the ability to learn new and complex computer system applications.
  • Must test at a minimum of 30-40 wpm typing with a high level of accuracy.


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