Customer Service Representative - Aspire Health

Montage Health•Monterey, CA

11d

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 personal, respectful, and meaningful support to community members. The representative is expected to be patient, empathetic, curious, and solution-oriented while balancing compassion with professionalism in a fast-paced environment. The position serves members, providers, and clients through phone, email, and occasional in-person interactions. It provides accurate and timely guidance, educates people about benefits and next steps, documents communications and actions, researches issues through resolution, and coordinates appeals and grievances with internal teams. The role also provides interdepartmental coverage as needed and performs other assigned duties.

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 setting.
Service-oriented approach and ability to resolve customer complaints and issues calmly and professionally.
Ability to operate spreadsheet and word-processing programs and computer equipment required for the position.
Exceptional diplomacy skills to resolve issues under tense or stressful circumstances.
Excellent phone manner.
Ability to use sound judgment, identify appropriate next steps, and develop solutions.
Proficiency in Microsoft Office Suite and strong Internet skills.
Ability to learn effectively through computer-based or online training.
Associate degree or applicable professional experience required.
Minimum 1 to 3 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 according to their needs and inquiries, helping them understand available benefits and next steps.
Document communications and actions in the appropriate system of record.
Research issues and work to resolve inquiries within established timeframes.
Coordinate member appeals and grievances 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.