Commercial Health Call Center Rep

Providing essential support to members and providers, the full-time remote Commercial Health Call Center Representative will manage inbound and outbound inquiries, delivering accurate information on health plan benefits, eligibility, claims, and billing while ensuring a compassionate customer experience. Key responsibilities Research and resolve member and provider inquiries, aiming for first-contact resolution while meeting departmental metrics Accurately explain plan benefits, eligibility, and claims decisions, utilizing knowledge of relevant coding systems Document escalated situations and collaborate with internal teams to address complex issues effectively Required qualifications High school diploma or equivalent required 2+ years of customer service experience supporting commercial fully insured health plan business Working knowledge of commercial health plan benefits, eligibility, and claims processes Demonstrated knowledge of CPT, ICD-10, HCPCS, and Revenue Codes; proficiency in Microsoft 365 required