Healthcare Customer Support Specialist I

Advanced Medical Management, Inc.; Long Beach (CA); On-site; USD 42,000 - 56,000; Full time

Benefits offered by this job

Health coverage

Flexible PPO plan

Vision & dental premiums

FSAs

401(k)

PTO & sick pay

Holidays

Job summary

Advanced Medical Management, Inc. seeks a Customer Service Representative I to serve as the primary contact for members, providers, and plans in a high-volume call center. You will address inquiries about claims, eligibility, service authorizations, and benefits, delivering accurate information with empathy.

The role requires strong problem-solving, time management, and professional communication. You will document interactions in CRM/EHR systems, follow scripts, and escalate complex issues as

Qualifications

• Minimum of 2 years of call center or customer service experience strongly preferred.

Responsibilities

• Manage a high volume of routine inbound calls from members, brokers, healthcare providers, and health plans, addressing inquiries related to claim status, eligibility, service authorizations, benefits, case management, etc.
• Verify and communicate member eligibility and benefits, and provide accurate, timely information regarding access to services
• Deliver claim status updates, complete check tracers, guide callers to the portal when appropriate and resolve routine inquiries during the initial call whenever possible
• Research, analyze, and resolve issues related to claims, eligibility, case management, authorizations or any other customer related request, ensuring thorough and timely resolution
• Conduct outbound follow-up calls, taking full ownership to ensure completion and resolution of outstanding issues
• Escalate complex or unresolved issues to senior representatives (CSR II/III) or the appropriate department as needed
• Accurately document all interactions, actions taken, and outcomes within CRM/EHR and proprietary systems
• Monitor for trends in call types (disposition) or issues and proactively communicate observations to management
• Meet or exceed established performance metrics, including call metrics, quality standards, and first-call resolution
• Perform additional duties as assigned

Skills

Verbal communication

Written communication

Active listening

Empathy

Problem solving

Time management

Organizational skills

Professional call handling

Cultural sensitivity

Attention to detail

Education

High school diploma or GED

Associate degree or higher preferred

Tools

CRM/EHR systems

Microsoft Office

Data entry

Job description

Advanced Medical Management, Inc. seeks a Customer Service Representative I to serve as the primary contact for members, providers, and plans in a high-volume call center. You will address inquiries about claims, eligibility, service authorizations, and benefits, delivering accurate information with empathy.

The role requires strong problem-solving, time management, and professional communication. You will document interactions in CRM/EHR systems, follow scripts, and escalate complex issues as