Customer Care Representative I

First Choice Health Network Inc; Washington (District of Columbia); Remote; USD 36,000 - 48,000; Full time

Benefits offered by this job

Health & Vision coverage

401(k) with company match

Paid PTO & Holidays

Tuition Reimbursement

Employee Assistance Program

Job summary

First Choice Health is seeking a Customer Care Representative I to provide courteous, accurate responses to routine employee benefits inquiries via phone, email, and chat. The role is remote and requires working hours from 6AM-7PM (8 hour shift).

Preference location includes Washington, Oregon, Idaho, Alaska, Nevada. You will handle inquiries about benefits, eligibility, claims, and provider locations, log interactions in the CRM, and comply with PHI confidentiality.

Qualifications

• High School Diploma or equivalent.
• 2+ years in customer service or similar role, with experience in healthcare or insurance preferred.

Responsibilities

• Phone and Queue Management: Handle all assigned routine inquiries regarding benefits, eligibility, claims, and provider/facility locations within the network.
• Customer Assistance: Answer member and provider calls about employee benefits and eligibility, claims payment and processing status.
• Issue Escalation: Route challenging or complex inquiries, especially emotional or difficult calls, to Customer Care Representative II or Senior.
• Documentation: Log each customer interaction and resolution in the CRM system and track action items related to the interaction as needed.
• Standards and Compliance: Meet KPIs for response time, accuracy, and adherence to call schedules, while ensuring confidentiality guidelines for PHI.
• Support and Teamwork: Support team goals by handling calls within the queue efficiently and escalating issues appropriately.
• Chat Support: Manage one or more chat sessions at a time to assist with basic customer inquiries.

Skills

Customer service phone skills

Written communication

Verbal communication

Empathy in service

Healthcare benefits knowledge

Provider networks

Time management

Prioritization

Multitasking

CRM systems

Google Workspace

Microsoft Office

Team collaboration

Education

High School Diploma or equivalent

2+ years in customer service (healthcare/insurance preferred)

Tools

CRM systems

Google Workspace

Microsoft Office Suite

Job description

Job Description

CUSTOMER CARE REPRESENTATIVE I

POSITION SUMMARY

The Customer Care Representative 1 provides courteous, accurate, and timely responses to routine employee benefits inquiries via phone, email, and chat from members and providers. This role involves handling standard inquiries and following up as needed, with support from senior representatives for complex issues. Bilingual proficiency (Spanish) is a plus. Individuals who thrive at First Choice Health exhibit the following success skills-- Caring, Transparency, Collaboration, Relentlessness, and Innovation.*This is a remote job that requires working hour from 6AM-7PM (8 hour shift).

Preference location- Washington, Oregon, Idaho, Alaska, Nevada.

RESPONSIBILITIES

• Phone and Queue Management: Handle all assigned routine inquiries regarding benefits, eligibility, claims, and provider/facility locations within the network.
• Customer Assistance: Answer member and provider calls about employee benefits and eligibility, claims payment and processing status.
• Issue Escalation: Route challenging or complex inquiries, especially emotional or difficult calls, to Customer Care Representative II or Senior.
• Documentation: Log each customer interaction and resolution in the Customer Relationship Management (CRM) system and track action items related to the interaction as needed.
• Standards and Compliance: Meet key performance indicators (KPIs) for response time, accuracy, and adherence to call schedules, while ensuring compliance with confidentiality guidelines for Protected Health Information (PHI).
• Support and Teamwork: Support team goals by handling calls within the queue efficiently and escalating issues appropriately.
• Chat Support: Manage one or more chat sessions at a time to assist with basic customer inquiries.

QUALIFICATIONS

• High School Diploma or equivalent.
• 2+ years in customer service or similar role, with experience in healthcare or insurance preferred.

SKILLS

• Has customer service phone skills.
• Strong written and verbal communication skills and an empathetic approach to customer service.
• Basic understanding of employee healthcare benefits and provider networks.
• Effective time management, prioritization and multitasking skills
• Competency with CRM systems, Google Workspace, and Microsoft Office Suite.
• Ability to work collaboratively in a team and seek guidance as needed.

PHYSICAL REQUIREMENTS

• Ability to see and hear within normal ranges with or without aid.
• Ability to bend, and move within normal ranges.
• Ability to be stationary for long periods of time.
• Finger and hand dexterity.
• Able to lift a minimum of 10-20 pounds.

ABOUT FIRST CHOICE HEALTH

First Choice Health, headquartered in Seattle, WA, is a provider-owned healthcare organization offering employers a forward-thinking alternative to traditional health insurance. We have been serving employers of all sizes and across many industries with exceptional health benefits administration for over 35 years, providing unparalleled access to a growing number of clinically integrated networks (CIN) and a traditional PPO. Alongside our Employee Assistance Program (EAP) addressing mental health and work-life balance, our services collectively support members in every step of their healthcare journeys.

At First Choice Health, we are proud to deliver the personalized, quality service our clients deserve, while reducing costs and keeping members healthy.

OUR PURPOSE, VALUES & CULTURE

Uniting providers, employers, and individuals, we deliver sustainable solutions that elevate the health and care of our communities.

CARE TRANSPARENT COLLABORATE RELENTLESS INNOVATE

We strive to uphold the above values and take steps to cultivate our culture through each one.

We work as a community, guided by our values and are unified in our mission to make healthcare access easier for everyone from all walks of life. Learn more about how we foster a culture of belonging.

At First Choice Health, we believe that a culture that fosters belonging - one that accept employees for who they are, nurtures creative thinking, and appreciates different perspectives drives our success. By cultivating an environment where every voice is valued, we empower our employees to bring their best selves to work, enable us to serve our clients and communities more effectively. We work as a community, guided by our values and are unified in our mission to make healthcare access easier for everyone from all walks of life.

BENEFITS

Health & Insurance

Medical (HSA and PPO plans) and Vision coverage, Dental plan, employer-provided Life Insurance, and Short- & Long-Term Disability coverage.

Financial & Retirement

Health Savings Account (HSA) with company contributions, Flexible Spending Account (FSA), 401(k) plan with an employer match, and discretionary Profit Sharing.

Time Off & Development

Paid Time Off (PTO) accrued based on tenure, Paid Holidays, community service, and Tuition Reimbursement for continuing education.

Support

Employee Assistance Program (EAP) for confidential professional counseling, and a Wellness program with rewards. Note: Benefits are subject to change with or without notice.

PHYSICAL REQUIREMENTS

1. Ability to see and hear at normal levels with or without aid.
2. Ability to sit for long periods of time.
3. Finger and hand dexterity.
4. Ability to bend and twist.

Access to PHI:Routine and limited and does not require manager approval - The duties of the position require routine contact with a limited set of PHI that does not require manager approval. Examples include claims adjudication.For California employees, please review Privacy Act: