Client Services Specialist, Tier 1 Support

Role Overview

• Provide prompt, personalized service via phone, email, and follow-up communication.
• Manage RingCentral inbound and outbound calls while maintaining professionalism and call quality.
• Deliver first-call resolution for benefit, reimbursement, billing, COBRA, claims, enrollment, and eligibility inquiries.
• Support members through Qualifying Life Events (QLEs), explaining required documentation and next steps.
• Assist with ID card requests, including research, reorders, and carrier follow-up.
• Handle overage dependent reviews, notifications, and eligibility processing.
• De-escalate emotionally charged situations using empathy, active listening, and clear communication.
• Complete and manage Salesforce Case Types, including: EE-Level Enrollment/Eligibility Cases (member adds, terms, demographic corrections, plan changes, etc.) ER-Level Employer Changes (group demographics, group adds/updates, corrections) ID Card Cases.
• Investigate and resolve benefit, reimbursement, denial, and claims-related questions.
• Own resolution of errors when they occur and ensure transparent communication with members and internal teams.
• Make outbound calls to gather missing information, provide updates, or close open cases.
• Fulfill one-off reporting requests for internal teams, brokers, or employers as needed.
• Maintain client records and document discrepancies or updates accurately.
• Provide general administrative support and contribute to special projects.
• Assist other business units when workload demands or cross-functional needs arise.
• Manage multiple systems in a dual‑monitor environment to support high call volume efficiently.
• Handle user management tasks within assigned systems as directed (e.g., access, updates, troubleshooting).
• Log into phone systems on time and adhere to scheduled breaks and productivity expectations.
• Maintain a distraction-free home workspace with reliable high-speed internet.
• Protect confidentiality and maintain compliance with HIPAA and privacy standards.

Requirements

• High school diploma or equivalent.
• 3–5 years of customer service experience; call center experience preferred.
• 1+ year in medical billing, benefits, insurance, or eligibility/enrollment support.
• Strong verbal and written communication skills; ability to multi-task and handle multiple priorities.
• Technically proficient in Microsoft Office and comfortable navigating CRM, phone systems, and administrative tools.
• Strong attention to detail and data accuracy.
• Experience managing sensitive information and difficult conversations with professionalism.
• Self‑motivated, organized, and able to manage time effectively in a remote environment.
• Knowledge of medical reimbursement, benefits administration, HIPAA, or COBRA regulations (preferred).
• Experience using Salesforce, Zoom, Microsoft Teams, or similar tools (preferred).
• Experience supporting diverse member populations (preferred).
• Background in eligibility processing, enrollment support, or carrier coordination (preferred).