Evry Health

Call Center Representative

• Research, review, and respond to inbound and outbound member and provider inquiries
• Resolve issues at first contact when possible while meeting turnaround times and department metrics
• Interpret and explain plan benefits, eligibility, cost-sharing, and claims payment decisions
• Provide provider support regarding claim status, prior authorization requirements, and payment details
• Support pharmacy and wellness vendor inquiries
• Own initial intake and documentation of escalated member and provider situations
• Collaborate with Claims, Medical Management, and other internal teams to resolve complex issues
• Accurately document every interaction in the designated CRM system
• Monitor call and inquiry patterns to surface trends to leadership
• Assist members with portal navigation and promote digital self-sufficiency

Commercial Health Call Center Representative

• Research, review, and respond to inbound and outbound member and provider inquiries
• Resolve issues involving benefits, eligibility, claims, and billing at first contact when possible
• Meet turnaround times and department metrics, including quality, AHT, ASA, and schedule adherence
• Interpret and explain plan benefits, eligibility, cost-sharing, and claims payment decisions
• Support providers with claim status, prior authorization requirements, and payment details
• Support pharmacy and wellness vendor inquiries
• Own initial intake and documentation of escalated member and provider situations
• Collaborate with Claims, Medical Management, and other internal teams to resolve complex issues
• Document every interaction in the designated CRM system
• Monitor call and inquiry patterns to surface trends to leadership
• Assist members with portal navigation and promote digital self-sufficiency

Commercial Health Call Center Representative

Bilingual Commercial Health Call Center Representative, Spanish