Commercial Health Call Center Representative

🔥 0 minutes ago

🤠 Texas – Remote

🤠 Texas – Remote

⏰ Full Time

🟢 Junior

🟡 Mid-level

📞 Call Center Representative

🚫👨‍🎓 No degree required

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Evry Health

WebsiteLinkedInAll Job Openings

51 - 200 employees

Founded 2017

⚕️ Healthcare Insurance

🤝 B2B

🧘 Wellness

Healthcare Insurance • B2B • Wellness

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 inquiries received from members and providers. • Employ active listening skills, demonstrate patience and empathy, and handle difficult calls tactfully, courteously, and professionally. • Effectively manage escalations within the department by ensuring appropriate accountability, sense of urgency, communication and follow through to closure. • Leverage company policies and procedures, benefits, claims, and eligibility to respond accurately to all inquiries. • Handle member complaints and complaint appeals. • Work with internal departments, vendors, business partners, providers, etc. to help coordinate problem solving in an effective and timely manner. • Demonstrate basic understanding of company billing guidelines and effectively interpret inquiries related to claims and claim payments. • Accurately document all calls. • Recognize trends and patterns in call types and engage leadership with suggested solutions. • Meet and maintain established department production and quality standards, on both an individual and team basis. • Assist members with navigating the member portal while encouraging them to becoming self-sufficient with our tools. • Demonstrate personal responsibility and accountability by meeting attendance and schedule adherence expectations. • Effectively excel in a virtual work environment through active participation in team huddles, supervisor 1:1s, instant messaging, and check-ins.

🎯 Requirements

• Minimum of 2 years of customer service experience supporting a commercial health plan (not just Medicare, Medicaid, or Pharmacy) • Experience collaborating and supporting business and operational units such as Claims, Medical Management and Appeals and Grievance. • Knowledge of medical and insurance industry terminology including CPT/ICD-10, HCPCS and Revenue Codes. • Excellent communication skills, both verbally and in writing, and can articulate and communicate complex topics to a broad audience. • Comfort working in a fast-paced, deadline-oriented work environment. • Strong attention to detail and problem-solving skills with a high level of accuracy. • Proficiency in Microsoft Office applications Word, Excel, Outlook OneNote, etc. • Prior experience using a CRM, preferably SalesForce. • Bonus: fluency in Spanish.

🏖️ Benefits

• 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