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Customer Service Representative
NationsBenefitsCustomer Service Representative answering member and provider inquiries for NationsBenefits’ healthcare fintech and supplemental-benefits solutions. Researching claims, explaining coverage, and resolving service issues.
Core Competencies
Role fitCore Competencies
Use this summary to align your resume positioning with the role.
Demonstrates expertise in customer service within the healthcare sector, with a strong focus on compliance with HIPAA regulations and the ability to analyze claims accurately. Proficient in educating members and providers on health plan benefits and navigating multiple systems to ensure a positive customer experience.
Highest-signal resume keywords
Customer Service ExperienceHIPAA ComplianceClaims AnalysisMedicare and Medicaid KnowledgeData Entry Skills
ATS Keywords
Tailor your resumeApplicant Tracking System Keywords
Tip: use these terms in your resume and cover letter to boost ATS matches.
Hard Skills
Claims AnalysisData Entry SkillsKnowledge of Medicare ProgramsKnowledge of Medicaid ProgramsResearch Skills
Soft Skills
Excellent Verbal CommunicationExcellent Written CommunicationProblem-Solving AbilitiesAttention to DetailAbility to Multitask
Certifications & Qualifications
High School DiplomaGED
Industry Keywords
HealthcareInsuranceCustomer SatisfactionCall Center ExperienceCare Management
About the role
Key responsibilities & impact- Answer inbound calls from members and providers regarding health plan benefits, claims, eligibility, and general inquiries
- Research, locate, and provide accurate information while ensuring a positive customer experience
- Resolve member service issues by identifying concerns, researching solutions, implementing appropriate resolutions, and escalating complex issues when necessary
- Review and analyze claims based on diagnosis codes, procedures, provider information, medical policies, contracts, and established policies and procedures
- Educate members and providers on benefits, coverage, and health plan processes
- Identify members who may benefit from care management or managed care interventions and collaborate with clinical staff to facilitate appropriate services
- Document all interactions accurately and thoroughly in accordance with company policies and regulatory requirements
- Maintain compliance with HIPAA and all applicable healthcare regulations
- Meet productivity, quality, attendance, and customer satisfaction standards
Requirements
What you’ll need- High School Diploma or GED required
- Minimum of one (1) year of customer service or call center experience preferred
- Healthcare, insurance, Medicare, or Medicaid experience preferred
- Strong computer and data entry skills
- Working knowledge of Medicare and Medicaid programs preferred
- Excellent verbal and written communication skills
- Strong problem-solving and critical-thinking abilities
- Ability to multitask and navigate multiple systems simultaneously
- Attention to detail and commitment to accuracy
- Ability to work independently and as part of a team
- Professional demeanor with a strong focus on customer satisfaction
- Maintain compliance with HIPAA and all applicable healthcare regulations
- Meet productivity, quality, attendance, and customer satisfaction standards
Benefits
Comp & perks- Website LinkedIn All Job Openings 1001 - 5000 employees Founded 2013 🏥 Healthcare 💼 Consulting 📦 Logistics 💰 Private Equity Round on 2022-04 Healthcare
- Consulting
- Logistics NationsBenefits is a leading healthcare technology company that specializes in providing financial technology solutions and supplemental benefits management. The company offers a variety of services, including hearing care through NationsHearing, health and wellness products via NationsOTC, and meal delivery through NationsMarket. NationsBenefits also provides specialized services like emergency assistance, healthcare transportation, and personalized health guidance using artificial intelligence. Their proprietary platforms, including Benefits Pro™, facilitate member support, benefit configuration, and e-commerce transactions. NationsBenefits focuses on improving member outcomes, closing care gaps, and enhancing satisfaction through advanced analytics and custom programs.