About the Role

Are you a people-focused customer service professional who enjoys helping others, solving problems, and making complicated information easier to understand? We’re looking for a Call Center Representative. In this role, you’ll serve as a trusted resource for participants navigating their health benefits, answering questions, resolving concerns, and helping people understand the processes and resources available to them.

This is more than a traditional customer service position. You’ll have the opportunity to build expertise in health benefits and insurance while developing strong communication, problem-solving, and client-service skills. Comprehensive training and support will be provided—you don’t need to be a benefits expert on day one.

Responsibilities

Provide friendly, professional, and empathetic customer service by phone, email, in person, and through written correspondence
Handle a high volume of participant calls while maintaining accuracy, professionalism, and a positive attitude
Answer questions regarding eligibility, health benefits, claims, self-payments, and other plan-related matters
Research participant questions and concerns to identify accurate answers and effective solutions
Explain claim payments and help participants understand why a claim may have been denied
Verify participant eligibility and benefits and coordinate updates with outside vendors
Collaborate with internal departments, healthcare providers, vendors, local unions, and employers to resolve participant concerns
Learn and apply organizational policies, benefit schedules, eligibility systems, claims systems, and other plan resources
Accurately document participant interactions and maintain complete and organized records
Assist participants with enrollment forms, working spouse forms, disability claims, special fund claims, and other benefit-related processes
Help participants navigate the website and online resources
Escalate complex questions or concerns to the appropriate team member when additional assistance is needed
Monitor and follow established procedures to ensure accurate and compliant handling of participant requests
Participate in special projects and provide support to the Customer Service team as needed

Qualifications

At least 1 year of phone-based customer service experience required; experience as a Customer Service Representative, Receptionist, Scheduler, Patient Care Coordinator, Claims Representative, or similar role is highly relevant
Previous experience in healthcare, health insurance, benefits administration, or a medical environment is strongly preferred
High School Diploma or equivalent required; college coursework or a degree is a plus
Ability to type at least 40 words per minute
Strong written and verbal communication skills with the ability to explain information clearly and professionally
Excellent customer service skills and a genuine desire to help others
Strong attention to detail and accuracy, particularly when working with participant information and benefits-related documentation
Comfortable handling a high volume of phone calls and working in a structured, rules-oriented environment
Strong problem-solving and investigative skills with the ability to research issues and identify appropriate solutions
Ability to remain patient, professional, and empathetic when interacting with frustrated or upset participants
Strong organizational skills with the ability to manage multiple tasks and priorities
Proficiency with Microsoft Office and general computer systems
Ability to work independently while also collaborating effectively with a team
Dependable and punctual, with a strong commitment to consistent attendance and being prepared to start work on time
Comfortable working 100% on-site in Rockville, MD
Willingness to work a potential schedule of 10:00 AM–7:00 PM
Bilingual skills are a plus