Archived listing. The details below describe a past opening.
We are looking for a Customer Service Representative to support member enrollment operations for a healthcare organization. This Long-term Contract position focuses on delivering responsive service, reviewing enrollment information for accuracy, and helping ensure members are added to the plan efficiently and correctly. The ideal candidate is organized, accurate, and comfortable communicating with both customers and internal teams while managing high-volume data and service requests.
Responsibilities:
- Handle incoming questions from members, applicants, clients, and internal departments by phone, email, and tracking systems, providing timely and accurate support.
- Review enrollment submissions for completeness, enter application details into internal databases, and update eligibility records with a high level of accuracy.
- Process member enrollments, disenrollments, and eligibility changes while following established procedures and service standards.
- Contact applicants or related parties to obtain missing details, clarify discrepancies, and confirm current enrollment status when needed.
- Investigate rejected transactions or enrollment errors, identify root causes, and take corrective action to move records forward.
- Partner with colleagues across operations and support teams to resolve exceptions and ensure member accounts are properly established.
- Maintain organized documentation and accurate records within enrollment and eligibility systems for audit readiness and ongoing reference.
- Perform routine file balancing and reconciliation activities on daily and monthly schedules to confirm data integrity across systems.
- Compare entered information against source documents to verify accuracy and reduce processing issues or downstream claim impacts.
- Associate’s degree or an equivalent combination of education and relevant work experience.
- At least 2 years of experience in customer service, enrollment support, or a related administrative healthcare environment.
- Previous data entry experience and working knowledge of Microsoft Office applications, including Excel and Word.
- Strong attention to detail with the ability to manage multiple systems and maintain accuracy in a fast-paced setting.
- Clear written and verbal communication skills with a detail-oriented approach to customer interactions.
- Ability to interpret procedures, follow regulatory guidelines, and complete basic business correspondence and arithmetic tasks.
- Experience in Medicare managed care or familiarity with Medicare-related guidelines is preferred.
- Background in inbound and outbound call support, order entry, or call center customer service is a plus.