**Experienced Customer Service Representative – Healthcare Insurance and Call Center Expertise**

At blithequark, we're on a mission to revolutionize the way people interact with healthcare insurance. As a Customer Service Representative, you'll play a vital role in delivering exceptional experiences to our members, providers, and plan sponsors. If you're passionate about healthcare, customer service, and making a difference in people's lives, we want to hear from you. **About blithequark** blithequark is a leading provider of innovative healthcare solutions, dedicated to empowering individuals and organizations to achieve better health outcomes. Our team of experts is committed to delivering exceptional service, fostering meaningful relationships, and driving positive change in the healthcare industry. As a Customer Service Representative at blithequark, you'll be part of a dynamic team that's passionate about making a difference. **Job Summary** We're seeking an experienced Customer Service Representative to join our remote team in the USA. As a key member of our customer service team, you'll be responsible for providing exceptional service to our members, providers, and plan sponsors. You'll be the primary point of contact for resolving issues, answering questions, and guiding individuals through their healthcare plans. If you're a customer service expert with a passion for healthcare, we want to hear from you. **Responsibilities** As a Customer Service Representative at blithequark, your key responsibilities will include: * Answering questions and resolving issues based on phone calls, letters, and emails from members, providers, and plan sponsors * Triaging issues and reassigning them to the appropriate staff member * Documenting and tracking contacts with members, providers, and plan sponsors * Guiding members through their healthcare plans, policies, and procedures * Providing emotional support and empathy to members, understanding their needs and building trusting relationships * Anticipating customer needs and providing related information to answer unasked questions * Using customer service threshold frameworks to make financial decisions and resolve member issues * Explaining members' rights and responsibilities according to contract terms * Processing claim referrals, new claim handoffs, nurse reviews, complaints, grievances, and appeals * Educating providers on self-service options and assisting with credentialing and recredentialing issues * Responding to requests from the Client's Law Document Center regarding litigation and lawsuits * Handling extensive file review requests * Assisting in the preparation of complaint trend reports and compiling claim data for customer audits * Determining medical necessity, applicable coverage provisions, and verifying member plan eligibility for incoming correspondence and internal referrals * Handling incoming requests for appeals and pre-authorizations not handled by Clinical Claim Management * Reviewing member claim history to ensure accurate tracking of benefit maximums and/or coinsurance/deductible * Performing financial data maintenance as necessary **Qualifications** To be successful as a Customer Service Representative at blithequark, you'll need: * High School or GED equivalent * Experience in a customer service environment, preferably in a transaction-based setting such as a call center or retail location * Healthcare insurance experience is a plus * Ability to work in a production environment * Excellent communication and interpersonal skills * Empathy and compassion for individuals dealing with healthcare issues * Ability to build trusting relationships and provide emotional support * Strong problem-solving and analytical skills * Ability to work in a fast-paced environment and prioritize multiple tasks * Proficiency in using technology, including CRM systems and Microsoft Office **Skills and Competencies** To excel as a Customer Service Representative at blithequark, you'll need: * Strong customer service skills, with a focus on empathy and compassion * Excellent communication and interpersonal skills * Ability to work in a team environment and collaborate with colleagues * Strong problem-solving and analytical skills * Ability to adapt to changing priorities and deadlines * Proficiency in using technology, including CRM systems and Microsoft Office * Ability to maintain confidentiality and handle sensitive information * Strong organizational and time management skills **Career Growth Opportunities and Learning Benefits** At blithequark, we're committed to helping our employees grow and develop their careers. As a Customer Service Representative, you'll have opportunities to: * Develop your skills and knowledge in healthcare insurance and customer service * Work with a dynamic team of experts in the healthcare industry * Participate in ongoing training and development programs * Take on new challenges and responsibilities as you grow in your role * Collaborate with colleagues to drive positive change in the healthcare industry **Work Environment and Company Culture** As a remote employee at blithequark, you'll have the flexibility to work from home and enjoy a comfortable and productive work environment. Our company culture is built on: * Collaboration and teamwork * Innovation and creativity * Empathy and compassion * Continuous learning and development * Diversity and inclusion **Compensation, Perks, and Benefits** As a Customer Service Representative at blithequark, you'll enjoy: * Competitive salary and benefits package * Opportunities for career growth and advancement * Flexible work arrangements, including remote work options * Ongoing training and development programs * Collaborative and supportive work environment * Recognition and rewards for outstanding performance **How to Apply** If you're a customer service expert with a passion for healthcare, we want to hear from you. To apply for this exciting opportunity, please submit your resume and cover letter to our secure website. We can't wait to hear from you! **Equal Opportunity Employer** blithequark is an equal opportunity employer, committed to diversity and inclusion. We welcome applications from qualified candidates of all backgrounds and perspectives. If you need assistance in completing this application or during any phase of the application process, please contact our HR Department. **E-Verify** blithequark has an official agreement (ID #132522) with the U.S. Department of Homeland Security, U.S. Citizenship and Immigration Services, Employment Verification Program (E-Verify). (Posting required by OCGA 13/10-91.) **Apply Now** Apply for this job