Healthcare Call Center

TEKsystems•San Diego, CA

2d•$25 - $25•Onsite

About The Position

This role involves handling a high volume of inbound calls related to health plan enrollment and benefits. The representative will educate members on various benefit options, assist with enrollment changes, and verify member information. A key aspect of the job is explaining financial details such as premiums, deductibles, and copays, as well as troubleshooting enrollment issues and documenting all interactions accurately. Maintaining compliance with HIPAA and company policies, and meeting performance metrics are crucial for success in this position, especially during peak enrollment periods.

Requirements

At least 1 year of call center experience.
Experience handling 60-80 calls per day.
Minimum of 6 months recent call center experience.
Basic computer and writing skills.
Experience in an environment that requires meeting KPIs.
Understanding of HIPAA compliance.
Experience with Medicare.
Experience with service recovery.
Experience in a fast-paced environment.
Experience handling grievance cases.
Investigatory skills – researching and looking into inquiries.
Must be able to come to Spectrum for training (830-5pm) DAILY.
Candidates need to be flexible to work all schedules to help with business needs.

Nice To Haves

Highly preferred healthcare call center experience.
More experience in health call centers is better.
Looking for candidates who have long-term assignments, not short stints.
Knowledge of current matters relating to health maintenance organizations, performance management, and customer satisfaction assessment and delivery.
Epic Experience preferred.
TalkDesk – preferred.
Looking for Local SD candidates.

Responsibilities

Handle high-volume inbound calls regarding health plan enrollment and benefits.
Educate members on available medical, dental, vision, and supplemental benefit options.
Assist with plan selection, enrollment changes, and qualifying life event requests.
Verify member eligibility and enrollment status.
Explain premiums, deductibles, copays, coinsurance, and out-of-pocket costs.
Troubleshoot enrollment issues and escalate complex cases as needed.
Accurately document all customer interactions in CRM and enrollment systems.
Maintain compliance with HIPAA and company policies.
Meet quality, productivity, and customer satisfaction metrics during peak enrollment periods.