Customer Service Representative

Pacer Group; United States; Remote; USD 25,000 - 36,000; Full time

Benefits offered by this job

Medical

Dental

Vision

401(k)

Job summary

Pacer Group is seeking a Customer Service Advocate to support Health Net during Open Enrollment. This fully remote contract role operates in the West Coast time zone and focuses on guiding members through benefits and questions with empathy and accuracy.

You will handle calls, document interactions, and adhere to HIPAA standards while working from a private home workspace and meeting training expectations.

Qualifications

• Experience with health benefits and enrollment processes.
• Ability to handle sensitive information with confidentiality.
• Strong communication and empathy in customer interactions.

Responsibilities

• Handle inbound calls about benefits eligibility/claims status.
• Gather and verify demographic information during calls.
• Use problem-solving to identify caller needs and escalate crises as needed.
• Document calls in standard systems and follow up to resolution.
• Maintain HIPAA-compliant workspace and data security at home.

Skills

Customer service

Communication skills

Problem solving

Active listening

HIPAA compliance

Tools

CRM software

Job description

This is a fully remote contract role operating in the West Coast time zone with our customer, Health Net, part of the Centene family one of the nation’s largest healthcare organizations.

Health Net’s mission is to make quality healthcare accessible and affordable for everyone, especially underserved communities.

As a Customer Service Advocate, you’ll be the first point of contact for members, helping them understand their benefits, resolve issues, and make a real difference in people’s lives.

This role supports Health Net’s Open Enrollment period the busiest and most impactful time of the year when members review and update their health plans. You’ll be guiding them through that process with empathy and accuracy.

Day to Day Duties:

• This is a full function call center role that goes above and beyond just answering incoming calls. The goal is to help achieve what the member’s needs, so they do not have to call back for the same question. This requires additional investigation during and after a call has ended and following through to ensure the members’ questions are being answered and completed correctly. Will require multi-tasking with multiple systems, databases and link resources.
• Incoming calls depend on business needs, no set amount as quality is the importance for this particular call center team
• Answer incoming healthcare contact center calls from members regarding benefits eligibility/claims status
• Gather and verify demographic information and document calls using standard computer software and systems
• Use tools and apply problem-solving skills to identify immediate caller needs, including potential crisis calls; elevate crisis calls according to standard operating procedures
• Use verbal and written communication strategies to effectively elicit information, gain confidence from caller and provide reassurance
• Answer inbound call and make outbound calls according to department policies and procedures
• Use active listening skills and interviewing techniques to accurately identify caller’s presenting concerns

Work From Home Policy:

• No time off within the first 7 weeks, training time is crucial, time missed for any reason can result in being too far behind to catch up in which the assignment would end
• Must maintain a HIPAA compliant workspace. No other individuals, including infants, should enter the room during work hours, and workspace must be in a private location where others cannot over-hear conversations as to maintain patient information security
• On screen training/meetings will occur every day and it is required for cameras to be on and to be dressed appropriately
• Able to work a full shift without leaving the workspace to tend to personal matters in the home (answering the door, frequent bathroom visits outside of break times, etc.)
• No other employment should conflict with work hours, and caring for dependents during business hours is prohibited
• Communication is key in this role while working remotely from the rest of the team. It is extremely important to communicate if there is any emergencies and need to step away and following any proper call out procedures if needed
• 3 weeks of classroom training learning how to utilize each system.
• 4 weeks of hub training including shadowing with preceptors and learning more of the questions they will face with members.
• Within first 60 days will have audit scores to gage understanding, after the 60 days audit scores will count towards their performance.
• Audit score goals are 95%-97%

BENEFITS :

• Medical
• Dental
• Vision
• 401(k)

EEOC Compliance: We are an equal opportunity employer, and all qualified applicants will receive consideration for employment.

DISCLAIMER AI Usage Policy: Pacer Group uses AI to assist in screening applications. Final hiring decisions are made by human recruiters based on qualifications and experience.