Job Description
Overview
The Customer Service Representative (CAC) handles all aspects of member/patient support, focusing on timely research and resolution of telephone inquiries. This role manages incoming calls to address questions about member eligibility, plan prescription benefits, and claim payment issues, as well as patient service needs such as updating billing information, establishing payment plans, resolving payment inquiries, and scheduling.
Success in this role requires clear communication, accurate documentation, strong problem-solving, and a service-oriented mindset to ensure an excellent experience on every call.
Education
High school diploma or equivalent (Required)
Certification/Licensure
No specific certification or licensure requirements
- Experience
- 1+ year of customer service experience (healthcare or contact center environment preferred)
- Experience assisting callers with eligibility/benefits, claims/payment resolution, billing updates, payment plans, and appointment scheduling
- Proficiency with CRM/EMR or call-tracking systems; accurate call documentation and follow-through
- Strong communication, de-escalation, and problem-solving skills; ability to manage a high call volume and meet performance KPIs
- Commitment to accuracy, confidentiality, and HIPAA/privacy compliance
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