Experienced Customer Service Representative – Remote Full-Time Opportunity with blithequark

Introduction to blithequark At blithequark, we share a singular, clear purpose: bringing our heart to every moment of your health. This purpose guides our commitment to deliver enhanced human-driven healthcare for a rapidly changing world. Embedded in our brand — with heart at its center — our motivation 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 each individual who works at blithequark to feel enabled by the role they play in transforming our culture and accelerating our ability to grow and deliver solutions to make healthcare more personal, convenient, and affordable. Job Overview We are seeking an experienced Customer Service Representative to join our team at blithequark. As the face of blithequark, you will influence individuals' service experience by handling customer care requests and issues via phone, web, or written correspondence. Your role will be to engage, consult, and educate individuals based on their unique needs, preferences, and understanding of blithequark plans, tools, and resources to guide them along a path to care. Key Responsibilities Respond to questions and resolve issues based on calls/letters from individuals, providers, and plan sponsors. Escalate emergencies to appropriate staff and record and track contacts with individuals, providers, and plan sponsors. Guide individuals through their plan of benefits, blithequark policy, and procedures, as well as being knowledgeable about resources to comply with any regulatory requirements. Make a personal connection with our individuals by understanding and engaging the member to the fullest to support their best health. Take ownership to understand the member's needs by building a trusting and caring relationship with the member completely. Anticipate customer needs and provide the customer with relevant information to address unasked questions, such as additional plan details, benefit plan details, member self-service tools, etc. Utilize customer support limit system to make financial decisions to resolve member issues. Explain member limitations as per contract. Process claim referrals, new case handoffs, nurse reviews, complaints (member/provider), and appeals (member/provider) via target system. Educate providers on our self-service options and help providers with credentialing and re-credentialing issues. Answer demands received from blithequark's Regulation Record Place regarding litigation and claims, and handle broad document review demands. Aid in the preparation of complaint pattern reports and assist with incorporating claim data for customer reviews. Determine clinical needs, relevant coverage policies, and verify member plan eligibility related to incoming communication and internal referrals. Handle incoming requests for authorizations and pre-approvals not handled by Clinical Case Management. Perform review of member claim history to ensure accurate tracking of benefit maximums and/or coinsurance/deductible. Perform financial data entry as needed. Utilize relevant system tools and resources to generate quality letters and spreadsheets in response to requests received. Essential Qualifications Bachelor's Degree or equivalent experience. Customer service experience in a transaction-based environment, such as a call center or retail store, is preferred, demonstrating the ability to be empathetic and compassionate. Experience in a production environment. Ability to multitask to efficiently accomplish tasks. Understanding of medical terminology. Effective oral and written communication skills. Proficient in Microsoft Word and Outlook. Ability to maintain accuracy and production standards. Interpersonal skills. Technical skills. Problem-solving skills. Attention to detail and accuracy. Preferred Qualifications Prior experience in a customer-facing role, preferably in a healthcare or insurance setting. Knowledge of healthcare plans, policies, and procedures. Experience with customer relationship management (CRM) software or other customer service platforms. Career Growth Opportunities and Learning Benefits At blithequark, we are committed to the growth and development of our employees. As a Customer Service Representative, you will have access to training and development programs, as well as opportunities for advancement within the company. You will be part of a dynamic team that values innovation, collaboration, and customer satisfaction. Work Environment and Company Culture Our company culture is built on the principles of heart, empathy, and compassion. We believe in creating a work environment that is supportive, inclusive, and respectful of all employees. As a remote worker, you will be part of a virtual team that is connected through technology and shared goals. We offer a range of benefits, including flexible work arrangements, professional development opportunities, and a comprehensive compensation package. Compensation, Perks, and Benefits We offer a competitive hourly rate of $30-$41 per hour, depending on experience. In addition to your compensation, you will enjoy the benefits of working for an organization that puts its heart into caring for its employees and communities. Our benefits package includes medical, dental, and vision coverage, as well as a 401(k) retirement savings plan, employee stock purchase plan, and paid time off. Conclusion 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 to join our team at blithequark. As a Customer Service Representative, you will play a critical role in shaping the customer experience and contributing to the success of our organization. Don't miss this chance to be part of a dynamic team that is dedicated to making a difference in the lives of our customers. Apply for this job