Archived listing. The details below describe a past opening.
We are looking for a Medical Customer Service Rep to support a healthcare organization serving members in Minneapolis, Minnesota. This is a Contract position for a customer-focused individual who can handle high-volume inquiries with accuracy, empathy, and efficiency. In this role, you will assist members with benefits-related questions, claims concerns, and provider billing issues while helping them understand available healthcare services and coverage options.
Responsibilities:
- Handle incoming calls from health plan members and provide clear guidance on benefits, coverage details, and claim-related questions.
- Investigate member concerns involving balances billed by providers and explain next steps for resolving payment or statement issues.
- Review provider network information to help members identify participating healthcare providers and facilities.
- Explain authorization guidelines for medical services and help callers understand when prior approval may be required.
- Support members with navigating healthcare services, including arranging or clarifying transportation scheduling when applicable.
- Document customer interactions thoroughly and maintain accurate records of inquiries, actions taken, and follow-up needs.
- Deliver attentive service in a fast-paced call center environment while meeting quality and response expectations.
- Previous experience in a call center or customer service position, preferably in a healthcare or health plan environment.
- Working knowledge of Medicaid programs, Medicaid eligibility, managed care, and related member services.
- Familiarity with medical claims, prior authorization processes, and provider or member billing questions.
- Strong verbal communication skills with the ability to explain complex information in a clear and supportive manner.
- Ability to manage multiple inquiries efficiently while maintaining accuracy and attention to detail.
- Comfortable using computer systems to review member information, document calls, and research coverage details.
- High level of professionalism, reliability, and commitment to delivering excellent member support.