Customer Service - Customer Service Representative Medicare 105-1087

CommunityCare•Tulsa, OK

About The Position

The Customer Service Representative is the first point of contact for membership-related questions, requests, and concerns. The role provides service to members and other callers by answering questions about benefits, eligibility, primary care providers, claims, and related topics; handling complaints; troubleshooting problems; and providing professional resolutions. The position requires a customer-focused, detail-oriented, results-driven approach, with the ability to adapt, learn, and work effectively with a team. The representative processes high volumes of inquiries across multiple products from members, providers, billing companies, legally represented individuals, employer groups, and other insurers. They aim to resolve inquiries on first contact, explain health insurance information clearly, resolve escalated issues, and meet call center performance standards while maintaining a positive customer experience. Flexible hours, including weekends and evenings, may be required depending on department or training needs and management discretion.

Requirements

High school diploma or equivalent.
One year of customer service experience involving direct customer interactions.
Exceptional telephone manner, customer service, active listening, verbal communication, and written communication skills.
Ability to resolve conflict and diffuse tension.
Strong time management and decision-making skills.
Ability to read, comprehend, and explain health insurance benefits clearly, concisely, and professionally.
Ability to work under stress while meeting production and quality standards.
Proficiency in Microsoft Office applications.
Strong organization and attention to detail.
Flexibility and ability to adapt to change.
Successful completion of a Health Care Sanctions background check.

Nice To Haves

Contact center or medical field experience preferred.
Bilingual skills are a plus.

Responsibilities

Process high volumes of incoming inquiries about multiple products from members, providers, billing companies, legally represented individuals, employer groups, and other insurance companies.
Strive for first-call resolution by communicating accurate information efficiently and promptly.
Verify eligibility, benefits, deductible amounts, claim status, copays, coinsurance, and other customer benefit or provider contract information.
Listen effectively to understand customer needs and complaints, offer appropriate solutions, and help members feel supported and valued.
Resolve escalated issues from members, providers, employer groups, or brokers while remaining calm and professional.
Provide interpretation services for product lines through the contracted language line service when appropriate.
Balance company and customer needs when resolving problems.
Adapt to organizational changes involving business processes, systems, and technology.
Build positive relationships based on teamwork, trust, reliability, and excellence.
Work toward meeting or exceeding call center metrics while providing excellent customer service.
Participate in training and other learning opportunities to expand knowledge of the company and position.
Perform other duties as assigned.