Commercial Health Call Center Representative (Healthcare)

TL;DR

Commercial Health Call Center Representative (Healthcare): Providing accurate information on commercial health plan benefits, eligibility, and claims with an accent on customer experience and professional communication. Focus on handling inbound/outbound calls, managing escalations, and navigating complex insurance terminology.

Location: Must live in/work from the United States in either the CST or EST time zone.

Company

hirify.global is the major medical division of Globe Life, focused on bringing a personalized, human approach to high-technology health insurance.

What you will do

• Research and respond to inquiries from members and providers regarding benefits, claims, and eligibility via calls and email.
• Handle inbound and outbound communications using active listening and empathy to manage difficult calls professionally.
• Effectively manage escalations, member complaints, and appeals with urgency and accountability.
• Leverage company policies and insurance guidelines to provide accurate information and resolve problems.
• Document all interactions accurately and identify call trends to suggest operational improvements to leadership.
• Assist members in utilizing the member portal to encourage self-sufficiency.

Requirements

• Minimum of 2 years of customer service experience supporting a commercial health plan (experience exclusively in Medicare, Medicaid, or Pharmacy is not sufficient).
• Must reside in the United States within the CST or EST time zones.
• Knowledge of medical and insurance terminology including CPT/ICD-10, HCPCS, and Revenue Codes.
• Proficiency in Microsoft Office applications (Word, Excel, Outlook, OneNote).
• Prior experience using a CRM, preferably Salesforce.
• Ability to maintain a dedicated, private, and secure home work area with high-speed internet.

Nice to have

• Fluency in Spanish.

Culture & Benefits

• Competitive salary and comprehensive health, dental, and vision insurance.
• Retirement savings plan with company match.
• Generous time off and vacation.
• Professional development opportunities.
• Fully remote work environment with a focus on humanity in healthcare.