Customer Care Specialist

Prime Therapeutics

Customer Care Specialist providing exceptional support for eligibility, benefits, and claims inquiries. Handling inbound and outbound calls and educating members and providers on various processes.

Posted 7/6/2026full-timeOrlando • Florida • 🇺🇸 United StatesMid-LevelSenior💰 $18 - $25 per hourWebsite

About the role

Key responsibilities & impact

Provide exceptional support to members and providers by addressing inquiries related to eligibility, benefits, claims, and service authorizations
Handle incoming calls and accurately document intake information into designated systems
Engage inbound callers professionally; actively listen and probe to determine the purpose of the call and resolve administrative concerns, including claims and dissatisfaction
Make outbound calls to solve member issues or additional information needed for a prior authorization
Research and communicate member information while maintaining confidentiality
Initiate care programs by accurately assembling and entering patient data
Educate providers and members on claims submission, treatment plans, appeal processes, and reimbursement rates
Identify and respond to crisis calls, assisting clinicians until resolution
Document interactions thoroughly; forward necessary information to appropriate staff and refer provider-related inquiries to the correct teams

Requirements

What you’ll need

High school diploma from an accredited school or GED
Must be eligible to work in the United States without the need for work visa or residency sponsorship
Must be flexible in scheduling and comfortable with change
Must be a proficient typist (avg. 35+ WPM) with strong written and verbal communication skills
Demonstrated ability to multi-task and maneuver through various computer platforms while verifying information on all calls
Familiarity with medical terminology, healthcare procedures, and insurance-related language to effectively support member and provider inquiries
Knowledge of HIPAA regulations and other healthcare compliance standards
Prior experience in a healthcare or insurance call center environment (preferred)
Previous customer service experience (preferred)
Previous experience with Genesys and CRM technology platforms (preferred)

Benefits

Comp & perks

Health insurance
401(k) matching
Paid time off

ATS Keywords

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Applicant Tracking System Keywords

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Hard Skills & Tools

Claims ProcessingEligibility VerificationService AuthorizationData EntryMulti-tasking

Soft Skills

Strong Written CommunicationStrong Verbal CommunicationActive ListeningProblem SolvingFlexibility