商业健康呼叫中心代表- 远程
Commercial Health Call Center Representative- Remote
职位概述
客户服务中心代表是Evry Health与会员和提供者之间的主要人工接触点，是公司致力于提供可及、准确和富有同理心的健康保险支持的体现。该职位以专业和关怀的方式处理来电和电子邮件咨询，提供关于商业健康计划福利、资格、索赔和账单的准确、详尽的信息，确保每次会员和提供者的互动都体现出Evry Health将人性化带入健康保险的使命。要求至少两年在商业健康计划（非仅限于Medicare、Medicaid或药房）客户支持方面的经验。合格的候选人还必须居住或工作在美国中部时间区（CST）或东部时间区（EST）。
关于Evry Health和Globe Life
我们致力于将人性化带入健康保险。我们的高科技健康计划扩展了福利，增加了获取和透明度，并采用个性化的、以人为本的方法。我们努力确保会员过上更幸福、更健康的生活。
Evry Health是Globe Life（纽约证券交易所代码：GL）的主要医疗部门。Globe Life目前有1680万份有效保单，拥有超过3000名公司员工和15000名代理。在过去连续45年中，Globe Life在A.M. Best Company的评级中获得了A（优秀）或更高的评级。
职位职责
- 会员及提供者咨询解决：研究、审查并回应来自会员和提供者的来电和邮件咨询，利用对福利、资格、索赔和账单的知识，在首次接触时尽可能解决问题。满足所有处理时间以及部门指标，包括质量、平均处理时间（AHT）、应答时间（ASA）、排班遵守率等。
- 福利、资格与索赔解释：准确解释计划福利、资格、共付额和索赔支付决定，应用对CPT、ICD-10、HCPCS和收入代码的了解。为提供者提供支持，包括索赔状态、事先授权要求、付款详情。支持药房和健康服务供应商的咨询。
- 升级处理：负责处理升级的会员和提供者情况的初步接待和记录。
- 跨职能协作与文档记录：与索赔、医疗管理和其他内部团队协作以解决复杂问题，并在指定的CRM系统中准确记录每次互动。
- 趋势识别与测量
查看英文原文
Role Summary
The Customer Service Representative is Evry Health's primary point of human contact for members and providers, serving as the face and voice of the company's commitment to accessible, accurate, and empathetic health insurance support. This role manages inbound and outbound calls and email inquiries with professionalism and care — delivering accurate, thorough information on commercial health plan benefits, eligibility, claims, and billing to ensure every member and provider interaction reflects Evry Health's mission of bringing humanity to health insurance. At least two years of experience in customer service supporting a commercial health plan (not just Medicare, Medicaid, or Pharmacy) is required. Eligible candidates also must live in/work from the United States in either the CST or EST time zone.
About Evry Health and Globe Life
We are on a mission to bring humanity to health insurance. Our high-technology health plans expand benefits, increase access and transparency, and feature a personalized, human approach. We strive to ensure members live happier, healthier lives.
Evry Health is the major medical division of Globe Life (NYSE:GL). Globe Life has 16.8 million policies in force, and more than 3,000 corporate employees and 15,000 agents. For more than 45 consecutive years, Globe Life has earned an A (Excellent) rating or higher from A.M. Best Company.
Roles and Responsibilities
- Member & Provider Inquiry Resolution: Researches, reviews, and responds to inbound and outbound member and provider inquiries, using knowledge of benefits, eligibility, claims, and billing to resolve issues at first contact when possible. Meets all turnaround times and department metrics, including quality, AHT, ASA, schedule adherence, etc.
- Benefits, Eligibility & Claims Explanation: Accurately interprets and explains plan benefits, eligibility, cost-sharing, and claims payment decisions, applying working knowledge of CPT, ICD-10, HCPCS, and Revenue Codes. Provides support to providers which includes claim status, prior authorization requirements, payment details. Supports pharmacy and wellness vendor inquiries.
- Escalation: Owns initial intake and documentation of escalated member and provider situations
- Cross-Functional Collaboration & Documentation: Collaborates with Claims, Medical Management, and other internal teams to resolve complex issues, and accurately documents every interaction in the designated CRM system.
- Trend Recognition & Member Portal Support: Monitors personal call/inquiry patterns to surface trends to leadership and assists members with portal navigation while promoting long-term digital self-sufficiency.
Qualifications
Required
- High school diploma or equivalent required
- 2+ years of customer service experience supporting commercial fully insured health plan business
- Working knowledge of commercial health plan benefits, eligibility & claims processes
- Demonstrated knowledge of CPT, ICD-10, HCPCS & Revenue Codes; Microsoft 365 proficiency required
Pereferred
- Associate's or Bachelor's degree in business, healthcare, or related field
- Experience supporting Claims, Medical Management, and/or Appeals and Grievance functions
- Proficiency with Salesforce or a comparable CRM system
- Experience identifying/reporting call trends or serving in an informal team lead/quality capacity
Telecommuting Requirements
- This is a remote position. Our whole company works remotely. Company headquarters are in Dallas, Texas.
- Company business hours are weekdays 9-5 CST. We will only consider candidates in the United States who reside in the CST or EST time zones.
- Required to have a dedicated work area established that is separate from other living areas and provides information privacy.
- Ability to keep all company sensitive documents secure.
- Must live in a location that receives an existing high-speed internet connection/service.
Benefits Package
- Competitive salary
- Comprehensive health, dental, and vision insurance as well as life and disability
- Retirement savings plan with company match
- Generous time off/vacation
- Professional development opportunities
- Flexible and remote work environment
Originally posted on Himalayas