Customer Care Representative

Key Responsibilities

• Serve as the frontline support for healthcare members, answering inquiries regarding plan coverage, benefits, and enrollment with empathy and clarity.
• Review, investigate, and explain complex medical billing statements, claims statuses, and payment discrepancies to members.
• Research and document all member interactions accurately across multiple data platforms and healthcare databases.
• Maintain strict adherence to healthcare privacy regulations (HIPAA) and company security protocols during every interaction.

Core Qualifications & Requirements

• Minimum of 1–2 years of experience in a BPO environment specifically handling Healthcare Member Services.
• Direct experience managing Benefits & Claims, Billing & Enrollment, or a combination of both.
• Solid foundational knowledge and hands-on experience handling medical billing processes and terminology.
• Proven background using CRM systems to log and manage customer files; Salesforce experience is highly preferred.
• Strong technical aptitude with the ability to learn complex proprietary software quickly, troubleshoot basic connectivity issues, and seamlessly multitask across dual monitors and multiple open applications.
• Excellent verbal and written English communication skills, with a proven ability to explain complex insurance concepts in simple terms.
• High School Diploma or equivalent required; Associate’s or Bachelor’s degree preferred.