Customer Service Agent

Role Overview

• Serve as the primary point of contact for providers, delivering accurate and timely assistance to inquiries such as claims status, benefit eligibility, prior authorization, etc.
• Utilize client-required systems and tools efficiently while adhering to established processes and compliance standards.
• Handle a wide range of provider interactions while maintaining brand voice and building trust.
• Demonstrate professionalism and empathy in every interaction, ensuring a positive customer experience aligned with client expectations.
• Meet or exceed key performance indicators (KPIs), including response time, resolution accuracy, and customer satisfaction scores.
• Participate in continuous improvement efforts and team initiatives.
• Engage in ongoing training and upskilling to maintain and enhance performance.
• Accurately document all interactions and outcomes in client systems to support reporting, analytics, and compliance obligations.
• Monitor and validate AI outputs to ensure accuracy, compliance, and alignment with customer standards.
• Review, correct, and approve AI-generated responses across workflows and simulations.
• Provide detailed feedback on AI performance, documenting errors, hallucinations, and improvement opportunities.
• Collaborate with managers, supervisors and engineering teams to refine prompts, improve model behavior, and support continuous tuning of AI systems.
• Maintain strong knowledge of customer knowledge bases, SOPs, and compliance requirements to ensure AI responses adhere to regulatory and brand guidelines.

Requirements

• High school diploma or GED
• Minimum of 2 years of experience in a contact center or customer service environment
• Fluent English proficiency with natural, conversational communication skills
• Strong customer service orientation with a professional, consistently polite demeanor
• High emotional intelligence with the ability to handle sensitive situations with empathy
• Excellent verbal and written communication skills, including grammar, clarity, and tone
• Familiarity with medical terminology, health plan documents or benefit plan design helpful
• Advanced typing skills (minimum 40 WPM preferred)
• Strong attention to detail and accuracy in all work
• Analytical thinking and problem-solving skills, including handling complex scenarios
• Ability to work independently with minimal supervision
• Strong time management and organizational skills
• Demonstrated reliability, accountability, and ability to meet performance standards

Benefits

• Comprehensive benefits package including medical, dental, life insurance, 401(k), flexible spending accounts, and paid time off
• Paid 2-week training program to help you build confidence, learn the role, and succeed from the start