**Experienced Customer Service Representative – Heart of Healthcare Support**

Are you passionate about delivering exceptional customer experiences and making a meaningful impact in the lives of others? Do you thrive in a fast-paced, dynamic environment where no two interactions are ever the same? If so, we invite you to join blithequark's team of dedicated professionals who share a single, clear purpose: Bringing our heart to every moment of your health. At blithequark, we're committed to delivering enhanced human-centric healthcare for a rapidly changing world. Our brand is built on a foundation of empathy, compassion, and a deep understanding of the complexities of healthcare. We believe that how we deliver our services is just as important as what we deliver, and that's why we're seeking a talented Customer Service Representative to join our team. **About the Role** As a Customer Service Representative at blithequark, you'll play a vital role in supporting our members, providers, and plan sponsors through a variety of channels, including telephone, internet, and written correspondence. You'll be the first point of contact for many of our customers, and your ability to listen, empathize, and resolve issues will be crucial in building trust and loyalty. **Key Responsibilities** * Handle customer service inquiries and problems via telephone, internet, or written correspondence * Answer questions and resolve issues based on phone calls/letters from members, providers, and plan sponsors * Triage resulting rework to appropriate staff * Document and track contacts with members, providers, and plan sponsors * Guide members through their plan of benefits, Aetna policy, and procedures, as well as provide knowledge of resources to comply with regulatory guidelines * Create an emotional connection with our members by understanding and engaging with them to champion their best health * Take accountability to fully understand member needs by building a trusting and caring relationship * Anticipate customer needs and provide related information to answer unasked questions * Use customer service threshold framework to make financial decisions to resolve member issues * Explain member 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 providers on self-service options and assist with credentialing and re-credentialing issues * Respond to requests received from Aetna's Law Document Center regarding litigation; lawsuits * Handle extensive file review requests * Assist in preparation of complaint trend reports * Assist in compiling claim data for customer audits * Determine medical necessity, applicable coverage provisions, and verify member plan eligibility relating to incoming correspondence and internal referrals * Handle incoming requests for appeals and pre-authorizations not handled by Clinical Claim Management * Perform review of member claim history to ensure accurate tracking of benefit maximums and/or coinsurance/deductible * Perform financial data maintenance as necessary * Use applicable system tools and resources to produce quality letters and spreadsheets in response to inquiries received **Essential Qualifications** * Customer service experience in a transaction-based environment, such as a call center or retail location, demonstrating ability to be empathetic and compassionate * Experience in a production environment **Preferred Qualifications** * Review required qualifications above **Education** * High School Diploma, GED, or equivalent experience **Compensation and Benefits** * The typical pay range for this role is $17.00 - $28.45 per hour * This pay range represents the base hourly rate or base annual full-time salary for all positions in the job grade within which this position falls * The actual base salary offer will depend on a variety of factors, including experience, education, geography, and other relevant factors * This position is eligible for a blithequark bonus, commission, or short-term incentive program in addition to the base pay range listed above * Enjoy the rewards of an organization that puts its heart into caring for its colleagues and communities * The Company offers a full range of medical, dental, and vision benefits * Eligible employees may enroll in the Company's 401(k) retirement savings plan, and an Employee Stock Purchase Plan is also available for eligible employees * The Company provides a fully-paid term life insurance plan to eligible employees, and short-term and long-term disability benefits * blithequark also offers numerous well-being programs, education assistance, free development courses, a CVS store discount, and discount programs with participating partners * As for time off, Company employees enjoy Paid Time Off (PTO) or vacation pay, as well as paid holidays throughout the calendar year **Why Join blithequark?** At blithequark, we're committed to creating a culture that values diversity, equity, and inclusion. We believe that our differences are what make us stronger, and we're dedicated to fostering an environment where everyone feels welcome, respected, and empowered to succeed. If you're passionate about delivering exceptional customer experiences and making a meaningful impact in the lives of others, we invite you to join our team of dedicated professionals who share a single, clear purpose: Bringing our heart to every moment of your health. **How to Apply** To apply for this exciting opportunity, please visit our website and submit your application. We can't wait to hear from you! Apply Job! Apply for this job