Claims Customer Service Representative II

Integrity Marketing Group; Clearwater (FL); On-site; USD 42,000 - 65,000; Full time

Job summary

Integrity Marketing Group in Clearwater, FL is seeking a Claims Specialist to review, process, and resolve inquiries about contract benefits and Medicare-related claims. You will document interactions, provide status updates, and ensure accurate policy files.

The role emphasizes clear communication with policyholders, agents, providers, and internal teams, maintaining a professional, customer-focused approach.

Qualifications

• High School Diploma or GED equivalent.
• 2-4 years of experience in a fast-paced call center or relevant experience.
• Preferred experience in medical insurance, especially Medicare Supplement plans.
• Strong communication skills, both verbal and written.
• Ability to clearly explain complex information in a customer-friendly manner.
• Proficient in claims systems and Microsoft Office applications.

Responsibilities

• Accurately interpret contract benefits and communicate details to policyholders, agents, and providers in a positive, professional manner.
• Provide clear and timely claim status updates to policyholders and providers.
• Prepare, send, and follow up on refund request letters as necessary.
• Create and deliver correspondence to customers as needed.
• Answer incoming calls and place outbound calls to provide or obtain information, ensuring all interactions are helpful, professional, and timely.
• Document all calls while in progress and fully update policy files or imaging systems to maintain a clear audit trail.
• Transfer calls to appropriate departments to ensure customer needs are met efficiently.
• Actively participate in cross-training and group training sessions to enhance team efficiency and uphold service standards.
• Maintain open communication with supervisors, team leads, and colleagues to ensure accurate responses and prevent duplication of efforts.
• Perform other duties as assigned to support the needs of the team.

Skills

Strong communication

Customer service experience

Attention to detail

Microsoft Office proficiency

Education

High School Diploma or GED

Job description

Job Summary: Review, process, investigate, and make informed decisions to accurately resolve both phone and written inquiries. Apply contract benefits by following established claims processing protocols. Report any issues related to claims processing systems to the appropriate team. Collect, organize, and utilize daily information about benefits, contract coverage, and policy determinations effectively. Maintain professional and positive relationships with external contacts such as policyholders, service providers, agents, attorneys, and other insurance carriers, as well as internal connections including coworkers, management, and support staff.

Primary Responsibilities

• Accurately interpret contract benefits and communicate details to policyholders, agents, and providers in a positive, professional manner.
• Provide clear and timely claim status updates to policyholders and providers.
• Prepare, send, and follow up on refund request letters as necessary.
• Create and deliver correspondence to customers as needed.
• Answer incoming calls and place outbound calls to provide or obtain information, ensuring all interactions are helpful, professional, and timely.
• Document all calls while in progress and fully update policy files or imaging systems to maintain a clear audit trail.
• Transfer calls to appropriate departments to ensure customer needs are met efficiently.
• Actively participate in cross-training and group training sessions to enhance team efficiency and uphold service standards.
• Maintain open communication with supervisors, team leads, and colleagues to ensure accurate responses and prevent duplication of efforts.
• Perform other duties as assigned to support the needs of the team.

Primary Skills & Requirements

• High School Diploma or GED equivalent
• 2-4 years of experience in a fast-paced call center or relevant experience
• Preferred experience in medical insurance, especially Medicare Supplement plans
• Strong communication skills, both verbal and written
• Ability to clearly explain complex information in a customer-friendly manner
• Proficient in claims systems and Microsoft Office applications
• Exceptional attention to detail and strong problem-solving abilities

About Integrity

Integrity is one of the nation’s leading independent distributors of life, health and wealth insurance products. With a strong insurtech focus, we embrace a broad and innovative approach to serving agents and clients alike. Integrity is driven by a singular purpose: to help people protect their life, health and wealth so they can prepare for the good days ahead.

Integrity offers you the opportunity to start a career in a family-like environment that is rewarding and cutting edge.

Why? Because we put our people first! At Integrity, you can start a new career path at company you’ll love, and we’ll love you back.

We’re proud of the work we do and the culture we’ve built, where we celebrate your hard work and support you daily.

Joining us means being part of a hyper-growth company with tons of professional opportunities for you to accelerate your career.

Integrity offers our people a competitive compensation package, including benefits that make work more fun and give you and your family peace of mind.

Headquartered in Dallas, Texas, Integrity is committed to meeting Americans wherever they are — in person, over the phone or online.

Integrity’s employees support hundreds of thousands of independent agents who serve the needs of millions of clients nationwide.

For more information, visit Integrity.com.

Integrity, LLC is an Equal Opportunity employer.

All qualified applicants will receive consideration for employment without regard to race, color, religion, sex, gender identity, national origin, disability, veteran status or any other characteristic protected by federal, state, or local law.

In addition, Integrity, LLC will provide reasonable accommodations for qualified individuals with disabilities.

Please note that all official communications from Integrity will come from @integrity.com or Workday domains.

Founded in 2006, Integrity develops and distributes life and health insurance products and wealth products with carrier partners and markets these products through our vast distribution network.

Our omnichannel platform helps provide life and health insurance and wealth management services to Americans to fit their unique needs.

Wherever you are in life, the future can be a leap of faith.