Health Care Customer Service Advocate

About the Company: We are seeking a dedicated Healthcare Customer Service Representative to join our team. This role involves assisting members with inquiries related to their insurance plans, eligibility, benefits, and claims. The ideal candidate will have a strong understanding of various insurance plan types and excellent communication skills.

About the Role: Healthcare Basics
• Recognize and understand various insurance plan types, including Commercial, Individual Products, HIX, and Government Plans (Medicaid/Medicare).
• Familiarity with common insurance terminology and procedures.

Key Responsibilities: • Phone Skills • Receive and respond to member inquiries via inbound calls using NICE inContact - Max Agent. • Make outbound calls to members, vendors, and other departments. • Follow established call flow processes for member interactions. • Understand and apply protocols for using the language line for effective communication. • * Eligibility and Enrollment • Verify member status, including ID numbers and personal information, using Salesforce, CSC, and QNXT. • Confirm member eligibility and plan effective dates. • Manage member correspondence, including sending plan documents and updating demographics.

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