Commercial Health Call Center Representative (Health Insurance)

TL;DR

Commercial Health Call Center Representative (Health Insurance): Providing accurate information on health plan benefits, eligibility, and claims for members and providers with an accent on exceptional customer service and empathy. Focus on managing complex escalations, interpreting medical billing guidelines, and improving operational processes.

Location: Remote (USA) - Must reside in the CST or EST time zone

Company

A major medical division of Globe Life, focusing on bringing a personalized, human approach to high-technology health insurance.

What you will do

• Research and respond to member and provider inquiries regarding benefits, claims, and eligibility.
• Manage escalations within the department to ensure timely closure and accountability.
• Handle member complaints and appeals professionally.
• Collaborate with internal departments and vendors to coordinate problem-solving.
• Document all calls accurately and identify trends to suggest process improvements.
• Assist members in using the member portal to increase self-sufficiency.

Requirements

• Minimum of 2 years of customer service experience supporting a commercial health plan (excluding Medicare, Medicaid, or Pharmacy).
• Must live and work within the United States in the CST or EST time zone.
• Knowledge of medical and insurance terminology (CPT/ICD-10, HCPCS, Revenue Codes).
• Proficiency in Microsoft Office (Word, Excel, Outlook, OneNote).
• Experience with CRM systems, preferably Salesforce.
• Ability to maintain a secure, private dedicated home work area with high-speed internet.

Nice to have

• Fluency in Spanish.

Culture & Benefits

• Comprehensive health, dental, and vision insurance, plus life and disability.
• Retirement savings plan with company match.
• Generous vacation and time-off policy.
• Professional development opportunities.
• Fully remote work environment.