Customer Service Representative (Remote)

Pinnacle Technology is a leading healthcare organization seeking an experienced Customer Service Representative to join their team. The role involves providing exceptional customer service to members and patients, handling inquiries related to healthcare benefits, and ensuring compliance with standards.

Responsibilities:

• Serve as the primary point of contact for members and patients, providing exceptional customer service
• Handle inbound calls regarding healthcare benefits, eligibility, claims, referrals, authorizations, and provider networks
• Research and resolve member concerns while ensuring timely follow-up and issue resolution
• Accurately document member interactions in healthcare information systems
• Coordinate with internal departments, providers, and health plans to ensure seamless service
• Maintain compliance with HIPAA and organizational quality standards
• Meet customer service, quality, and productivity goals in a fast-paced call center environment

Requirements:

• High School Diploma, GED, or equivalent
• Minimum 3 years of healthcare customer service or member services experience
• Experience working in a healthcare, managed care, or health plan environment
• Excellent verbal and written communication skills
• Strong documentation and data entry skills
• Proficiency with Microsoft Office and computer systems
• Ability to manage multiple priorities while maintaining accuracy
• Prior experience successfully working in a remote environment
• Experience with EPIC Tapestry, CRM systems, or similar healthcare platforms
• Experience supporting health plans or managed care organizations