Overview The Customer Service Representative (CAC) handles all aspects of member/patient support, focusing on timely research and resolution of telephone inquiries. This role manages incoming calls to address questions about member eligibility , plan prescription benefits , and claim payment issues , as well as patient service needs such as updating billing information , establishing payment plans , resolving payment inquiries , and scheduling . Success in this role requires clear communication, accurate documentation, strong problem-solving, and a service-oriented mindset to ensure an excellent experience on every call.
Requirements
High school diploma or equivalent (Required)
Certification/Licensure No specific certification or licensure requirements
Experience 1+ year of customer service experience (healthcare or contact center environment preferred) Experience assisting callers with eligibility/benefits , claims/payment resolution , billing updates , payment plans , and appointment scheduling Proficiency with CRM/EMR or call-tracking systems; accurate call documentation and follow-through Strong communication, de-escalation , and problem-solving skills; ability to manage a high call volume and meet performance KPIs Commitment to accuracy, confidentiality, and HIPAA /privacy compliance