Key Responsibilities

• Respond to inbound inquiries regarding healthcare benefits, eligibility, claims status, and account information.

• Assist patients and members in understanding healthcare plans, coverage details, and policy guidelines.

• Resolve billing concerns, payment issues, and account discrepancies.

• Document all interactions, requests, and resolutions in the system accurately.

• Coordinate with internal departments, insurance carriers, or healthcare providers to resolve complex concerns.

• Follow HIPAA, privacy, and compliance regulations when handling sensitive health information.

• Meet performance metrics including quality, productivity, and customer satisfaction targets.

• Provide first‑call resolution whenever possible.

• Educate customers on available services, processes, and self‑service options.

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