Customer Service Representative

KMC Solutions; Medellín; On-site; COP 13,392,000 - 20,088,000; Full time

Job summary

KMC Solutions is seeking a Customer Service Representative onsite in Medellín to support members and providers with healthcare benefit questions, eligibility checks, and claims inquiries. You will deliver a high-quality concierge experience while navigating multiple systems.

The ideal candidate has healthcare call center experience, strong communication skills, attention to detail, and a willingness to learn new systems, processes, and HIPAA-guided confidentiality.

Qualifications

• At least 2 years of healthcare customer service or healthcare call center experience.
• Understanding of healthcare terminology including: claims, provider networks.
• Strong written and verbal communication skills.
• Ability to multitask and navigate multiple systems while assisting customers.

Responsibilities

• Answer inbound calls from members and healthcare providers in a professional, customer-focused manner.
• Assist members with inquiries about ID cards, provider networks, and eligibility verification.
• Assist providers with inquiries about member eligibility and general provider support.
• Document all interactions and follow-up items according to procedures.
• Navigate multiple healthcare systems and resources to research and resolve inquiries.
• Follow HIPAA guidelines and keep member information confidential.
• Take ownership of concerns and work toward first-contact resolution.
• Identify issues that need escalation and follow the escalation process.
• Support continuous improvement by spotting trends and process gaps.

Skills

Healthcare CS

Written & verbal comms

Multitasking & systems

Tools

CRM platforms

Ticketing systems

Call center platforms

Job description

Customer Service Representative ONSITE | Full-time

Position Overview Our client is looking for experienced Healthcare Customer Service Representatives to support its members and providers. You’ll deliver a high-quality concierge experience by assisting with healthcare benefit questions, eligibility, claims inquiries, provider searches, and issue resolution. The ideal candidate has healthcare call center experience, strong communication skills, attention to detail, and the ability to navigate multiple systems while providing accurate, empathetic support.

Responsibilities

• Answer inbound calls from members and healthcare providers in a professional, customer-focused manner.
• Assist members with inquiries about:
• ID cards
• Provider network information
• Assist providers with inquiries about:
• Member eligibility verification
• General provider support
• Accurately document all interactions, actions taken, and follow-up items according to established procedures.
• Navigate multiple healthcare systems and resources to research and resolve inquiries.
• Follow HIPAA guidelines and keep member information confidential.
• Take ownership of member and provider concerns and work toward first-contact resolution.
• Identify issues that need escalation and follow the correct escalation process.
• Support continuous improvement by spotting trends, process gaps, and ways to improve the customer experience.

Qualifications

• Required:
• At least 2 years of healthcare customer service or healthcare call center experience.
• Understanding of healthcare terminology, including:
• Claims
• Provider networks
• Strong written and verbal communication skills.
• Ability to multitask and navigate multiple systems while assisting customers.
• Ability to work onsite in Makati if residing in the Philippines, or in Medellín if residing in Colombia
• Strong attention to detail and accurate documentation.

Required Skills

• Healthcare customer service or healthcare call center experience.
• Understanding of healthcare terminology (Eligibility, Benefits, Claims, Provider networks, Prior authorization basics).
• Strong written and verbal communication skills.
• Ability to multitask and navigate multiple systems while assisting customers.
• Ability to work onsite in Makati if residing in the Philippines, or in Medellín if residing in Colombia.
• Strong attention to detail and accurate documentation.

Preferred Skills

• Experience supporting members and/or providers for a health plan, TPA, insurance company, benefits administrator, or healthcare organization.
• Medical insurance or TPA experience.
• Member Services and/or Provider Services experience.
• Knowledge of self-funded health plans.
• Experience researching claims, benefits, eligibility, and provider information.
• Experience using CRM, ticketing, or call center platforms.

Pay range and compensation package

Not specified.

Equal Opportunity Statement

Not specified.

What We’re Looking For

• Start-up ready
• Empathy and professionalism
• Strong problem-solving skills
• Ownership and accountability
• Ability to adapt in a growing, startup environment
• Willingness to learn new systems and processes