Customer Service Representative - Aspire Health

Montage Health•Monterey, CA

13d

About The Position

The Customer Service Representative I is the front-line contact for local Medicare Advantage health plan members and healthcare partners. The role handles inbound calls and inquiries about eligibility, benefits, and claims, and provides personalized, respectful support to members and partners in the community. It calls for patience, empathy, curiosity, and solution-oriented problem solving in a fast-paced environment. The representative serves members, providers, and clients through phone, email, and occasional in-person interactions. They provide accurate and timely information, educate people about benefits and next steps, document communications, research issues through resolution, coordinate appeals and grievances with internal teams, and provide interdepartmental coverage as needed.

Requirements

Excellent verbal and written communication skills, including active listening.
At least three years of experience in customer service, a call center, or a similar role.
Service-oriented approach and ability to resolve customer complaints and issues while maintaining a professional, calm demeanor.
Ability to operate spreadsheet and word-processing programs and computer equipment required for the role.
Exceptional diplomacy skills to resolve issues under tense or stressful circumstances.
Excellent phone manner.
Ability to use sound judgment, identify next steps, and develop appropriate solutions.
Associate degree or applicable professional experience required.
One to three years of experience in customer service, hospitality, or a call center.

Nice To Haves

Bilingual Spanish/English.

Responsibilities

Serve as a primary point of contact for members, providers, and clients via phone, email, and occasional in-person interactions.
Assist with questions related to eligibility, benefits, claims status, prior authorization requirements, and appeals.
Provide accurate, timely, and compassionate responses to customer inquiries.
Educate members and providers based on their needs and inquiries, helping them understand available benefits and next steps.
Thoroughly document communications and actions in the appropriate system of record.
Research issues and work to resolve each inquiry within established timeframes.
Coordinate member appeals and grievances in collaboration with appropriate internal teams.
Provide support and coverage for interdepartmental staff as needed to ensure continuity of service.
Perform other duties and responsibilities as assigned.