Healthcare Customer Service Representative

Amerit Consulting; California (MO); Remote; USD 40,000 - 48,000; Full time

Job summary

Amerit Consulting seeks a Healthcare Customer Service Representative for a 6-month remote assignment supporting a CA-resident client in the PBM sector. The role requires handling eligibility, benefits, and claims inquiries with strong confidentiality.

Candidates must have 3–5 years of healthcare or pharmaceutical customer service experience, HS diploma or GED, and a 40+ WPM typing speed. Training is provided; shifts span 6am–10pm PT with weekend options.

Qualifications

• High School diploma or GED.
• 3–5 years of healthcare or pharma customer service.
• Typing speed of 40+ WPM with ability to talk and type simultaneously.
• Flexible and comfortable with change in a dynamic environment.
• Ability to maneuver through multiple computer platforms while verifying information.

Responsibilities

• Answer inbound calls about eligibility, benefits, claims and authorization.
• Enter intake data into the appropriate systems.
• Explain eligibility, benefits, EAP services, claim status and authorization inquiries.
• Resolve administrative concerns as the first line of contact and manage claim resolutions when needed.
• Enter patient information to initiate EAP, Care and Utilization management programs.
• Educate providers on claim submission and treatment plan submission.
• Inform providers and members about in-network and out-of-network reimbursement.
• Refer callers to Provider Services and Care Management teams.

Skills

Customer Service

Communication

Typing 40+ WPM

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 Healthcare 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.

I'd love to talk to you if you think this position is right up your alley, and assure prompt communication, whichever direction. If you are looking for rewarding employment and a company that puts its employees first, we'd like to work with you.

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.