Healthcare Customer Service Specialist

Role Overview

• Answer inbound calls and place outbound calls to assist members or patients with inquiries, benefits, scheduling, and service coordination
• Provide accurate information about health plan benefits, eligibility, and coverage
• Schedule, reschedule, and confirm appointments with healthcare providers
• Process referrals, authorizations, prescription renewals, and other requests
• Assist members or patients with claims questions, billing inquiries, and account updates
• Review insurance or plan eligibility and update records in the system
• Maintain accurate documentation in electronic systems, including EMR or CRM tools
• Communicate with providers and internal teams via phone, secure messaging, or email
• Protect member and patient confidentiality and follow HIPAA or applicable privacy guidelines
• Escalate complex issues to the appropriate team or supervisor for resolution

Requirements

• High School Diploma or equivalent
• 1+ year of call center customer service experience handling high call volume
• 1+ year of healthcare or health insurance experience (member services, patient services, provider services, benefits support, or similar)
• Previous job tenure of at least 6 months per role, reflecting stability and reliability
• Knowledge of privacy regulations and the ability to manage sensitive customer and account information with discretion, ensuring full compliance in a remote work environment
• Strong verbal and written communication skills
• Ability to navigate multiple systems and maintain accuracy while handling calls
• Comfortable working in a remote environment with a designated, private workspace
• Demonstrated stable work history with a track record of reliability
• Commitment to a long-term role and building a career with the organization
• Reliable high-speed internet.
• Preferred Qualifications: Experience with appointment scheduling or benefits inquiries; Familiarity with electronic medical records (EMR) or customer relationship management (CRM) systems; Experience with EPIC, Facets, or similar applications; Knowledge of medical and/or insurance terminology.

Benefits

• Medical, Dental, and Vision coverage.
• Life Insurance.
• Short-Term and Long-Term Disability options.
• Flexible Spending Account (FSA).
• Employee Assistance Program.
• 401(k) with employer contribution.
• Paid Time Off (PTO).
• Tuition Reimbursement.