Premium Healthcare Customer Service Representative

Job Summary

We are seeking a highly professional and customer-focused Premium Health Customer Service Representative to provide exceptional support to members enrolled in premium healthcare plans. In this role, you will assist with benefit inquiries, eligibility verification, claims, billing, provider information, and other healthcare-related concerns while delivering a personalized, high-quality customer experience. The ideal candidate is empathetic, detail-oriented, and committed to exceeding customer expectations.

Key Responsibilities

• Handle inbound and outbound customer interactions related to premium healthcare plans and services.
• Assist members with inquiries regarding benefits, eligibility, claims status, billing, coverage, and provider networks.
• Explain healthcare policies, plan features, and available services in a clear and professional manner.
• Resolve customer concerns efficiently while ensuring a positive and personalized experience.
• Coordinate with healthcare providers, insurance partners, and internal departments to resolve complex issues.
• Accurately document customer interactions and update member records in the system.
• Maintain confidentiality of protected health information (PHI) and comply with HIPAA and company policies.
• Meet or exceed quality assurance, productivity, and customer satisfaction performance goals.
• Stay up to date with healthcare regulations, products, and account processes.

Qualifications

• High School Graduate or Senior High School Graduate (College graduates are preferred).
• At least 6 months of customer service or BPO experience; healthcare account experience is an advantage.
• Excellent verbal and written English communication skills.
• Strong interpersonal, problem-solving, and active listening skills.
• Ability to multitask and navigate multiple computer applications efficiently.
• Willing to work on shifting schedules, weekends, and holidays.
• Amenable to onsite, hybrid, or work-from-home arrangements, depending on business needs.

Preferred Qualifications

• Experience handling healthcare insurance, medical, HMO, or member services accounts.
• Knowledge of healthcare terminology, insurance benefits, claims processing, and eligibility verification.
• Strong attention to detail and commitment to delivering a premium customer experience.

Benefits

• Competitive salary package
• Performance-based incentives
• HMO coverage and life insurance
• Paid training and continuous learning opportunities
• Paid vacation and sick leaves
• Government-mandated benefits
• Career growth and internal promotion opportunities
• Supportive and inclusive work environment