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Commercial Health Call Center Representative- Remote

4 hours, 26 minutes ago
United States
Full-time
Junior
Customer Support
Customer and Technical Support
CRM Salesforce
Apply Now
Evry Health

Evry Health

Evry Health is a modern health insurance company that prioritizes delivering great benefits at affordable prices. They offer a unique approach to health insurance by focusing on making members healthier and happier through personalized care from a dedi...

Insurance
11-50
Founded 2017
$7M raised
View All Jobs 4

Description

  • Resolve inbound and outbound member and provider inquiries, aiming for first-contact resolution while meeting quality, turnaround-time, and productivity metrics.
  • Explain plan benefits, eligibility, cost-sharing, and claims payment decisions accurately.
  • Support providers with claim status, prior authorization requirements, and payment details, as well as pharmacy and wellness vendor inquiries.
  • Document and manage the initial intake of escalated member and provider situations.
  • Collaborate with Claims, Medical Management, and other internal teams to resolve complex issues.
  • Record all interactions accurately in the designated CRM system.
  • Identify inquiry and call trends and communicate findings to leadership.
  • Assist members with portal navigation and encourage long-term digital self-service.

Requirements

  • High school diploma or equivalent.
  • At least 2 years of customer service experience supporting a commercial fully insured health plan; Medicare, Medicaid, or pharmacy-only experience does not qualify.
  • Working knowledge of commercial health plan benefits, eligibility, and claims processes.
  • Knowledge of CPT, ICD-10, HCPCS, and Revenue Codes.
  • Proficiency with Microsoft 365.
  • Preferred: Associate’s or bachelor’s degree in business, healthcare, or a related field.
  • Preferred: Experience with Claims, Medical Management, or Appeals and Grievance functions.
  • Preferred: Salesforce or comparable CRM experience.
  • Preferred: Experience identifying and reporting call trends or serving in an informal team lead or quality role.
  • Must reside and work in the United States in the CST or EST time zone, with access to high-speed internet and a private, secure workspace.

Benefits

  • Competitive salary.
  • Comprehensive medical, dental, vision, life, and disability insurance.
  • Retirement savings plan with company match.
  • Generous paid time off and vacation.
  • Professional development opportunities.
  • Fully remote and flexible work environment.

Interested in this position?

Apply directly on the company website

Apply Now

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