Customer Service Representative
Job Summary
The Customer Service Representative handles daily operations for a health insurance provider, including member interactions and back-office tasks. The role requires following standard procedures to manage caseloads and support leadership in service delivery. This is a remote-based position specifically for candidates residing in Georgia.
Responsibilities
- Manage member and provider inquiries via multiple channels
- Maintain caseload productivity and quality standards
- Monitor and resolve work-in-progress issues
- Ensure compliance with PHI and regulatory standards
Required Skills
- 1+ years customer service experience
- 6+ months healthcare industry experience
- Bilingual: Spanish and English proficiency
- Proficiency in Google Suite or Microsoft Office
- Strong analytical and problem-solving skills
Job Details
Responsibilities:
- Develop a comprehensive understanding of the current processes, procedures, and tools associated with the Oscar business model.
- Work with members, brokers, providers, and Oscar vendors through multiple channels according to assignment needs.
- Manage an assigned caseload, maintaining service delivery, productivity, and quality expectations.
- Form working relationships with all partners.
- Support the leadership team by identifying issues through established escalation pathways.
- Monitor and track the health of all assigned work-in-progress issues.
- Escalate and resolve issues to ensure appropriate turnaround times.
- Participate in process improvement projects.
- Comply with all operational, regulatory, and compliance standards relating to member Personal Health Information (PHI).
- Compliance with all applicable laws and regulations.
- Other duties as assigned.
Requirements:
- 1+ years of experience in a high-volume or customer-focused setting.
- 6+ Months of healthcare experience.
- High school diploma or GED.
- Strong quantitative or analytical skills focused on identifying or solving problems.
- Must be bilingual in Spanish and English with full professional proficiency in reading, writing, and speaking.
- Experience manipulating and entering accurate data.
- Advanced Google Suite or Microsoft Office capabilities.
Benefits:
- Eligible for employee benefits and monthly vacation accrual at a rate of 15 days per year.
- Medical, dental, and vision benefits.
- 11 paid holidays, paid sick time, paid parental leave.
- 401(k) plan participation.
- Life and disability insurance, and paid wellness time and reimbursements.