Customer Support Representative - Missouri Work-from-Home

PacificSource Health Plans

14d•Remote

About The Position

Looking for a way to make an impact and help people? Join PacificSource and help our members access quality, affordable care! PacificSource is an equal opportunity employer. All qualified applicants will receive consideration for employment without regard to status as a protected veteran or a qualified individual with a disability, or other protected status, such as race, religion, color, sex, sexual orientation, gender identity, national origin, genetic information or age. PacificSource values the diversity of our community, including those we hire and serve. We are committed to creating and fostering a work environment in which individual differences and diversity are appreciated, respected and responded to in ways that fully develop and utilize each person’s talents and strengths. Provide excellent customer service primarily by telephone to all PacificSource customers. Assist customers with coverage/claims related questions. Accurately interpret benefits and policy provisions for all PacificSource products. Conduct appropriate research and follow-up for prompt resolution of disputed claims. Essential Responsibilities: Work efficiently in a high volume call center while maintaining a professional, positive, and caring demeanor. Assist callers with coverage related questions/concerns; accurately interpret policy provisions for assigned products. Analyze customer’s inquiries and determine correct steps for resolution, interpret benefit information, and claims processing accuracy. Keep resource information up to date and well organized. Work efficiently in multiple systems simultaneously while effectively utilizing critical thinking and problem solving skills. Document calls in a clear and consistent manner in computer system. Conduct appropriate research, take ownership and follow through for prompt resolution of disputed claims. Relay information to appropriate departments and personnel using established communication channels and procedures. Make outbound calls to members as necessary dependent upon current outreach campaign. Supporting Responsibilities: Meet department and company performance and attendance expectations. Be aligned with PacificSource company values. Follow the PacificSource privacy policy and HIPAA laws and regulations concerning confidentiality and security of protected health information. Perform other duties as assigned. SUCCESS PROFILE Work Experience: One-year medical insurance, other healthcare related field, call center or customer service experience required. CPT/ICD-10 coding preferred. Education, Certificates, Licenses: High School Diploma or equivalent required. Knowledge: Basic understanding of insurance and medical terminology, coding and standard medical billing practices preferred. Proficient computer skills, typing, and 10-key required. Strong written and verbal communication skills. Competencies: Building Customer Loyalty Building Strategic Work Relationships Contributing to Team Success Planning and Organizing Continuous Improvement Adaptability Building Trust Work Standards Environment: Work inside in a general office setting with ergonomically configured equipment. Travel is required approximately less than 5% of the time. Skills: Accountability, Collaboration, Communication (written/verbal), Flexibility, Listening (active), Organizational skills/Planning and Organization, Problem Solving, Teamwork Compensation Disclaimer The wage range provided reflects the full range for this position. The maximum amount listed represents the highest possible salary for the role and should not be interpreted as a typical starting wage. Actual compensation will be determined based on factors such as qualifications, experience, education, and internal equity. Please note that the stated range is for informational purposes only and does not constitute a guarantee of any specific salary within that range. Base Range: $32,311.65 - $51,698.64 Our Values We live and breathe our values. In fact, our culture is driven by these seven core values which guide us in how we do business: We are committed to doing the right thing. We are one team working toward a common goal. We are each responsible for customer service. We practice open communication at all levels of the company to foster individual, team and company growth. We actively participate in efforts to improve our many communities-internally and externally. We actively work to advance social justice, equity, diversity and inclusion in our workplace, the healthcare system and community. We encourage creativity, innovation, and the pursuit of excellence. Physical Requirements: Stoop and bend. Sit and/or stand for extended periods of time while performing core job functions. Repetitive motions to include typing, sorting and filing. Light lifting and carrying of files and business materials. Ability to read and comprehend both written and spoken English. Communicate clearly and effectively. Disclaimer: This job description indicates the general nature and level of work performed by employees within this position and is subject to change. It is not designed to contain or be interpreted as a comprehensive list of all duties, responsibilities, and qualifications required of employees assigned to this position. Employment remains AT-WILL at all times. PacificSource is anything but a typical health insurance company. Founded in 1933, we’re an independent, not-for-profit organization that puts our members, and their communities first—across Idaho, Oregon, Montana, and Washington. It's our employees who make it happen: promoting health equity and partnering with providers to deliver better access to optimal, affordable care. So yes, with PacificSource, you get to do great things. In our effort to put members first—more than 525,000 of them—initiative, commitment, and hard work are supported and rewarded with excellent benefits, competitive wages, and opportunities for personal growth and advancement. Benefits: Flexible telecommute policy, medical, vision, and dental insurance, incentive program, paid time off and holidays, 401(k) plan, volunteer opportunities, tuition reimbursement and training, life insurance, and options such as a flexible spending account. We love our common purpose. Empowerment, flexibility, and sharing success make for a great place to work. Here’s what else we feel good about: A mission with a real sense of shared values Competitive wages and outstanding benefits, including telecommuting Opportunities for learning development and career advancement Organizational leadership style rooted in servant and transformational leadership A commitment to support the communities we serve A belief in the importance of work-life balance April 22: University of Oregon Healthcare Career Fair, 11a-2p PST, 1395 University St., Eugene, OR PacificSource is an equal opportunity employer and a company that loves helping people. We work with our employees to understand their goals, and provide training, individual development, and career advancement opportunities to help them achieve just that. Top Workplace 2025 and 2024 USA | USA Today 2025 Healthcare Top Workplaces | Energage Top Workplaces # 6 Healthiest Employer of Oregon 2025 | Portland Business Journal Top Workplace 2024, 2023 and 2022 for Oregon and SW Washington | The Oregonian Top Workplace 2025, 2024, 2023 and 2022 for the Treasure Valley | Idaho Press Certified Age Friendly Employer, 2023 | Age Friendly Institute PacificSource is an equal opportunity employer. Click here to review our AAP Policy Statement. If you have questions about working at PacificSource or need help with your application, please email [email protected].

Requirements

One-year medical insurance, other healthcare related field, call center or customer service experience required.
High School Diploma or equivalent required.
Proficient computer skills, typing, and 10-key required.
Strong written and verbal communication skills.

Nice To Haves

CPT/ICD-10 coding preferred.
Basic understanding of insurance and medical terminology, coding and standard medical billing practices preferred.

Responsibilities

Work efficiently in a high volume call center while maintaining a professional, positive, and caring demeanor.
Assist callers with coverage related questions/concerns; accurately interpret policy provisions for assigned products.
Analyze customer’s inquiries and determine correct steps for resolution, interpret benefit information, and claims processing accuracy.
Keep resource information up to date and well organized.
Work efficiently in multiple systems simultaneously while effectively utilizing critical thinking and problem solving skills.
Document calls in a clear and consistent manner in computer system.
Conduct appropriate research, take ownership and follow through for prompt resolution of disputed claims.
Relay information to appropriate departments and personnel using established communication channels and procedures.
Make outbound calls to members as necessary dependent upon current outreach campaign.
Meet department and company performance and attendance expectations.
Be aligned with PacificSource company values.
Follow the PacificSource privacy policy and HIPAA laws and regulations concerning confidentiality and security of protected health information.
Perform other duties as assigned.