Commercial Health Customer Service Representative

🕒 4 days ago

🇺🇸 United States – Remote

💵 $55k / year

⏰ Full Time

🟢 Junior

🟡 Mid-level

💝 Customer Support

🚫👨‍🎓 No degree required

👻 Ghost score 1%

What it means: how likely this posting is sitting open without active hiring.How to read it: 60% or higher means we think this is a ghost. Lower scores are less of a worry.How we score it: age, reposts, open roles vs team size, how fast jobs close, and whether pay is listed.Fine print: an estimate from public data, not a judgment of the company. Real jobs can score high, so treat it as a hint, not a fact.

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Evry Health

WebsiteLinkedInAll Job Openings

51 - 200 employees

Founded 2017

🏥 Healthcare

💼 Consulting

🛡️ Insurance

Healthcare • Consulting • Insurance

Evry Health is a modern, mobile-first health insurance company that provides fully insured employer health plans and personalized care teams. Built for midsize and larger employers (primarily in Texas), Evry offers no-copay, no-deductible plans, 24/7 virtual care, integrated wellness programs, and individualized support from nurses, nutritionists, and doctors to simplify costs and improve employee health. The company emphasizes a human, member-focused approach and digital tools (iOS/Android app) to deliver care and benefits.

📋 Description

• Research, review, and respond to inbound and outbound member and provider inquiries • Resolve issues at first contact when possible while meeting turnaround times and department metrics • Explain plan benefits, eligibility, cost-sharing, and claims payment decisions • Support providers with claim status, prior authorization requirements, and payment details • Support pharmacy and wellness vendor inquiries • Own initial intake and documentation of escalated member and provider situations • Collaborate with Claims, Medical Management, and other internal teams to resolve complex issues • Accurately document every interaction in the designated CRM system • Monitor call and inquiry patterns to surface trends to leadership • Assist members with portal navigation and promote long-term digital self-sufficiency

🎯 Requirements

• 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, and claims processes • Demonstrated knowledge of CPT, ICD-10, HCPCS, and Revenue Codes • Microsoft 365 proficiency required • Must live and work in the United States in the CST or EST time zone • Dedicated work area separate from other living areas that provides information privacy • Ability to keep company sensitive documents secure • Must live in a location with existing high-speed internet service

🏖️ Benefits

• Competitive salary • Comprehensive health, dental, and vision insurance • Life and disability insurance • Retirement savings plan with company match • Generous time off/vacation • Professional development opportunities • Flexible and remote work environment