Experienced Customer Service Representative - Remote Work Opportunity in Florida for a Leading Healthcare Company - blithequark

Welcome to blithequark At blithequark, we are driven by a single, clear purpose: to bring our heart to every moment of your health. This purpose guides our commitment to deliver enhanced human-centric health care for a rapidly changing world. Anchored in our brand — with heart at its center — our purpose sends a personal message that how we deliver our services is just as important as what we deliver. Our Heart At Work Behaviors support this purpose, empowering everyone who works at blithequark to feel valued by the role they play in transforming our culture and accelerating our ability to innovate and deliver solutions to make health care more personal, convenient, and affordable. About the Role We are seeking an experienced Customer Service Representative to join our team in Florida. As a Customer Service Representative, you will be the primary point of contact for our members, providers, and plan sponsors, providing exceptional customer service and resolving issues in a timely and professional manner. This is a remote work opportunity, and you must be able to work from home with a reliable internet connection and a dedicated workspace. Key Responsibilities Answer questions and resolve issues based on phone calls/letters from members, providers, and plan sponsors, triaging resulting rework to appropriate staff. Provide excellent customer service for high-volume inbound provider calls for the Claims Inquiry/Claims Research team, conducting extensive claims research on multiple platforms to assist providers with payment questions. Provide customers with related information to answer unasked questions, such as additional plan details, benefit plan details, member self-service tools, and more. Use customer service threshold framework to make financial decisions to resolve member issues, explaining members' rights and responsibilities in accordance with contract. Process claim referrals, new claim handoffs, nurse reviews, complaints (member/provider), grievance and appeals (member/provider) via target system. Educate and assist providers on our self-service options, helping with credentialing and re-credentialing and contracting questions and issues. Assist in compiling claim data for customer audits, determining medical necessity, applicable coverage provisions, and verifying member plan eligibility relating to incoming correspondence and internal referrals. Requirements To be successful in this role, you must meet the following requirements: MUST live in the state of Florida full-time. Familiarity with Microsoft Office products. Experience in a highly transactional call center environment. Excellent customer service and critical thinking skills. High-speed internet access (25 mbps or higher) and a consistent connection. Work location must be set up with a direct connection to the router (NOT Wi-Fi). We provide a 6 ½ foot long ethernet cord; if the distance is further, you will be required to provide your own ethernet cable. Education A High School diploma or GED equivalent is required for this role. What We Offer At blithequark, we offer a competitive pay range of $17.00 – $25.15 per hour, depending on experience, education, geography, and other relevant factors. In addition to your compensation, you will enjoy the rewards of an organization that puts our heart into caring for our colleagues and our communities. Our benefits package includes: A full range of medical, dental, and vision benefits. Eligibility to enroll in our 401(k) retirement savings plan. An Employee Stock Purchase Plan. A fully-paid term life insurance plan. Short-term and long-term disability benefits. Numerous well-being programs. Education assistance. Free development courses. A blithequark store discount. Discount programs with participating partners. Paid Time Off (PTO) or vacation pay. Paid holidays throughout the calendar year. Career Growth and Development At blithequark, we are committed to helping our employees grow and develop in their careers. We offer a range of training and development programs, including: Comprehensive onboarding program. Ongoing training and development opportunities. Career advancement opportunities. Mentorship programs. Cross-functional training. Work Environment and Company Culture At blithequark, we pride ourselves on our positive and supportive work environment. Our company culture is built on the values of: Respect. Integrity. Compassion. Excellence. Innovation. We believe in fostering a culture of inclusivity, diversity, and belonging, where everyone feels valued and supported. How to Apply If you are a motivated and customer-focused individual who is passionate about delivering exceptional service, we encourage you to apply for this exciting opportunity. Please submit your application, including your resume and a cover letter, to be considered for this role. Conclusion At blithequark, we are dedicated to making a positive impact on the lives of our customers and our communities. If you share our passion for delivering exceptional customer service and are looking for a challenging and rewarding career opportunity, we invite you to join our team. Apply now to become a part of our dynamic and supportive team and take the first step towards a fulfilling and successful career with blithequark. Apply for this job