A Customer Service Representative interacts directly with customers to answer questions and solve problems. Communicates with customers in person, over the phone or online. Provides help with troubleshooting technical problems for equipment or software. Keeps records of customer communications and transactions.
Purpose of Position
The Customer Service Representative I is the friendly, knowledgeable front line for our local Medicare Advantage health plan members and healthcare partners. In this role, you'll handle inbound calls and inquiries related to eligibility, benefits, and claims—while serving as a trusted advocate for the people who live, work, and age in the same communities we do.
Our members aren't just voices on the phone—they're our neighbors, friends, and family members. That's why this role is so critical. We're looking for someone who genuinely enjoys helping people of all ages, brings patience and empathy to every conversation, and takes pride in delivering support that feels personal, respectful, and meaningful. We're looking for naturally curious, solution-oriented problem solvers who can balance compassion with professionalism in a fast-paced environment.
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 all customer inquiries
Proactively educate members and providers based on their specific needs and inquiries, helping them better understand available benefits and next steps
Thoroughly document all communications and actions in the appropriate system of record
Research issues and work diligently to bring each inquiry to resolution within established timeframes
Coordinate member appeals and grievances in collaboration 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
Position Requirements
Excellent verbal and written communication skills, including active listening.
Minimum three years' experience in customer service, call center, or similar.
Service-oriented; Ability to resolve customer complaints and issues while maintaining a professional and calm demeanor.
Ability to operate spreadsheet, word processing programs and computer equipment required to fulfill position responsibilities.
Exceptional diplomacy skills to effectively resolve issues under sometimes tense and stressful circumstances.
Excellent phone manner
Ability to use sound judgement, identify next steps to be taken, and develop appropriate solutions.
English and Bilingual Spanish/English desired.
Competencies
Accountability and Dependability:
Assumes responsibility for accomplishing duties in an effective and timely manner.
Integrity:
Consistently honors commitments and takes responsibility for actions and words.
Software and Computer Skills:
Proficient in the use of Microsoft Office Suite, skilled at using the Internet. Type by touch. Must learns effectively with computer-based and/or online training.
Flexibility:
Demonstrates adaptability and openness to alternative solutions and flexibility when interacting with others, understanding their attitudes, needs, interests, and perspectives.
Inclusiveness:
The ability to network and partner with all internal and external stakeholders including broad and diverse representation of private/public and traditional/non-traditional community organizations.
Skills and Education
Associates degree, or applicable professional experience, required.
Minimum 1 to 3 years experience in a customer service, hospitality, or call center.
Benefits Competitive benefit package
Salary Commensurate with experience $21.00 - $23.00
Shift differential paid for evening and weekend hours
Equal Opportunity Employer
Assigned Work Hours:
Various schedules. May include evenings (to 8pm) and weekends.
