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Commercial Health Call Center Representative
Evry Health. Research, review, and respond to inbound and outbound member and provider inquiries .
About the role
Key responsibilities & impact- 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
Requirements
What you’ll need- 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 & claims processes
- Demonstrated knowledge of CPT, ICD-10, HCPCS & Revenue Codes
- Microsoft 365 proficiency required
- Eligible candidates must live in/work from the United States in either the CST or EST time zone
- Dedicated work area separate from other living areas, providing information privacy
- Ability to keep all company sensitive documents secure
- Must live in a location with existing high-speed internet service
Benefits
Comp & perks- Competitive salary
- Comprehensive health, dental, and vision insurance as well as life and disability
- Retirement savings plan with company match
- Generous time off/vacation
- Professional development opportunities
- Flexible and remote work environment