Claims Customer Service Representative II

Integrity Marketing Group•Clearwater, FL

About The Position

Review, process, and investigate claims and phone or written inquiries, making informed decisions to resolve them accurately. Apply contract benefits according to established claims-processing protocols, identify and report issues with claims-processing systems, and organize and use information about benefits, contract coverage, and policy determinations. Maintain positive, professional relationships with policyholders, service providers, agents, attorneys, other insurance carriers, and internal colleagues and support staff.

Requirements

High school diploma or GED equivalent.
2–4 years of experience in a fast-paced call center or relevant experience.
Strong verbal and written communication skills.
Ability to explain complex information clearly in a customer-friendly manner.
Proficiency with claims systems and Microsoft Office applications.
Exceptional attention to detail and strong problem-solving abilities.

Nice To Haves

Experience in medical insurance, especially Medicare Supplement plans.

Responsibilities

Interpret contract benefits and communicate coverage details to policyholders, agents, and providers professionally.
Provide timely claim-status updates to policyholders and providers.
Prepare, send, and follow up on refund-request letters when necessary.
Create and deliver customer correspondence as needed.
Answer incoming calls and make outbound calls to provide or obtain information.
Document calls as they occur and update policy files or imaging systems to maintain a clear audit trail.
Transfer calls to appropriate departments to address customer needs.
Participate in cross-training and group training sessions.
Communicate with supervisors, team leads, and colleagues to support accurate responses and avoid duplicated work.
Report claims-processing system issues to the appropriate team.
Perform other duties as assigned to support the team.