Call Center Customer Service Representative

Amerit Consulting; California; Remote; USD 25,000 - 33,000; Full time

Job summary

Amerit Consulting seeks a Call Center Customer Service Representative for a California resident-only, 100% remote position. The role supports eligibility, benefits, claims, and service authorization for a PBM provider.

Training is conducted remotely, with shifts across 24/7 operations, and requires strong multitasking in a healthcare environment. Ideal candidates have 3–5 years of healthcare customer service experience, high-speed typing, and the ability to navigate multiple systems while

Qualifications

• 3–5 years of customer service experience in Healthcare or Pharma.
• Typing speed of 40+ WPM with strong written and verbal communication.
• Flexible and comfortable with change in a dynamic environment.
• Ability to navigate multiple computer platforms while assisting callers.

Responsibilities

• Answer incoming calls about eligibility, benefits, claims and service authorization.
• Enter patient information into the delivery systems for EAP and related programs.
• Educate providers on claim submissions and treatment plan processes.
• Explain appeal procedures and network reimbursement details to callers.
• Refer complex cases to care management or appropriate teams.
• Triage calls and provide accurate information while maintaining confidentiality.

Skills

Healthcare customer service

Typing 40+ WPM

Adaptable to change

Multisystem navigation

Education

High School diploma or GED

Job description

Our client, a major PBM (Pharmacy Benefit Services) entity owned by 20 non-profit health plans serving >33 million members and benefits manager of government programs including Medicare and Medicaid, seeks an accomplished Call Center Customer Service Representative.

IMPORTANT NOTES:

• CLIENT IS HIRING CANDIDATES CALIFORNIA RESIDENTS ONLY.
• LOCATION: 100% REMOTE/ WORK FROM HOME
• DURATION: 6 months assignment with potential of extension
• WORK SHIFTS: Client Ops are 24/7. Hires would be spread across shifts, so candidates must be flexible to any of below shifts / schedules [Candidates must be available to work either both weekend days OR one weekend day].
• SHIFT / WORKING HOURS: 8 hours between 6am - 10pm Pacific || No Graveyard Shift || Can be any 5 days of the week (including one weekend)
• Training: 5 Weeks Total || (3 weeks) 8:00am - 5:00pm || (2 Weeks) 8:00am - 4:30pm (Success Lab)
• TIME-OFF POLICY: No time-off during Training || No absences in first 90 days preferred

IMPORTANT Remote / Work-From-Home related:

• Equipment will be provided.
• Candidate MUST have reliable Internet connection- (No WI-FI) ethernet connection At least 150MBPS(Uninterrupted).
• Candidate MUST have a reliable home-office environment.
• Client provides 2-meter LAN cable for endpoint connectivity from modem / router to laptop.
• Video Camera: Required to be on during Training / Team meetings etc.
• Work From Home location: be quiet and free from interruptions.

RESPONSIBILITIES:

• Answering incoming calls related to eligibility, benefits, claims and authorization of services from members or providers.
• Responsibilities also include administration of intake documentation into the appropriate systems.
• Researches and articulately communicates information regarding member eligibility, benefits, EAP services, claim status, and authorization inquiries to callers while maintaining confidentiality.
• Resolve customer administrative concerns as the first line of contact - this may include claim resolutions and other expressions of dissatisfaction.
• Comprehensively assembles and enters patient information into the appropriate delivery system to initiate the EAP, Care and Utilization management programs.
• Educates providers on how to submit claims and when/where to submit a treatment plan.
• Informs providers and members on Client's appeal process.
• Links or makes routine referrals and triage decisions not requiring clinical judgment.
• Provides information regarding Client's in-network and out-of-network reimbursement rates and states multiple networks to providers.
• Refers callers requesting provider information to Provider Services regarding Client's professional provider selection criteria and application process.
• Refers patients / EAP clients to Client's Care Management team for a provider, EAP affiliate, or Facility.

QUALIFICATIONS / REQUIREMENTS:

• At least High School diploma or equivalent (GED).
• Candidate must have 3-5 years of Customer Service experience handling high call volume within Healthcare or Pharma Industry.
• Typing speed of 40+ WPM with strong written / verbal communication skills, must be able to talk and type simultaneously.
• Flexible and comfortable with change in the ever-changing environment of customer service.
• Ability to maneuver through various computer platforms while verifying information on phone calls.

Jatin Rattan

www.ameritconsulting.com

Company Overview:

Amerit Consulting is an extremely fast-growing staffing and consulting firm. Amerit Consulting was founded in 2002 to provide consulting, temporary staffing, direct hire, and payrolling services to Fortune 500 companies nationally; as well as small to mid-sized organizations on a local & regional level. Currently, Amerit has over 2,000 employees in 47 states. We develop and implement solutions that help our clients operate more efficiently, deliver greater customer satisfaction, and see a positive impact on their bottom line. We create value by bringing together the right people to achieve results. Our clients and employees say they choose to work with Amerit because of how we work with them - with service that exceeds their expectations and a personal commitment to their success. Our deep expertise in human capital management has fueled our expansion into direct hire placements, temporary staffing, contract placements, and additional staffing and consulting services that propel our clients’ businesses forward.

Amerit Consulting provides equal employment opportunities to all employees and applicants for employment and prohibits discrimination and harassment of any type without regard to race, color, religion, age, sex, national origin, disability status, genetics, protected veteran status, sexual orientation, gender identity or expression, or any other characteristic protected by federal, state or local laws.

This policy applies to all terms and conditions of employment, including recruiting, hiring, placement, promotion, termination, layoff, recall, transfer, leaves of absence, compensation and training. Applicants, with criminal histories, are considered in a manner that is consistent with local, state and federal laws.