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Commercial Health Customer Service Representative
Evry Health. Research, review, and respond to inbound and outbound member and provider inquiries .
Core Competencies
Role fitCore Competencies
Use this summary to align your resume positioning with the role.
Demonstrates expertise in customer service within the commercial health plan sector, with a strong understanding of benefits, eligibility, and claims processes. Proficient in documenting interactions and collaborating with internal teams to resolve complex member and provider inquiries.
Highest-signal resume keywords
Customer Service ExperienceKnowledge of Commercial Health Plan BenefitsFamiliarity with CPT, ICD-10, HCPCS, and Revenue CodesMicrosoft 365 ProficiencyCRM Documentation Skills
ATS Keywords
Tailor your resumeApplicant Tracking System Keywords
Tip: use these terms in your resume and cover letter to boost ATS matches.
Hard Skills
Customer ServiceClaims ProcessingBenefits ExplanationEligibility AssessmentIssue ResolutionDocumentationTrend MonitoringPortal Navigation AssistancePrior Authorization KnowledgePayment Details Support
Soft Skills
CollaborationProblem-SolvingCommunicationAttention to DetailTime Management
Tools & Technologies
CRM SystemMicrosoft 365
Industry Keywords
Commercial Health PlanCPTICD-10HCPCSRevenue CodesClaims StatusMember InquiriesProvider InquiriesDigital Self-SufficiencyInformation Privacy
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
- 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
- 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 long-term 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, and claims processes
- Demonstrated knowledge of CPT, ICD-10, HCPCS, and Revenue Codes
- Microsoft 365 proficiency required
- Must live and work in the United States in the CST or EST time zone
- Dedicated work area separate from other living areas that provides information privacy
- Ability to keep 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
- Life and disability insurance
- Retirement savings plan with company match
- Generous time off/vacation
- Professional development opportunities
- Flexible and remote work environment