Job Details

Fully Remote - 9AM-5PM CST hours

About the Role

Seeking a Call Center Representative. Call Center Representatives provide accurate and thorough information on plan benefits, eligibility, and claims.You will handle inbound and outbound calls as well as respond to email inquiries from our customers. In this role, you may be responsible for developing process, call scripts, metrics, and desk top procedures. The role is responsible to deliver an exceptional customer service experience to our members and providers. This role reports to the Sr. Director Claims and Customer Support and Manager of Claims and Customer Support.

Key Responsibilities

• Research, reviews and responds to inquiries received from members and providers.
• Employs active listening skills, demonstrates patience and empathy, and can handle difficult calls tactfully, courteously and professionally.
• Effectively manages escalations within the department by ensuring appropriate accountability, sense of urgency, communication and follow through to closure.
• Leverages company policies and procedures, benefits, claims, and eligibility to respond accurately to all inquiries.
• Handles member complaints and complaint appeals.
• Works with internal departments, vendors, business partners, providers, etc. to help coordinate problem solving in an effective and timely manner.
• Demonstrates basic understanding of company billing guidelines and can effectively interpret inquiries related to claims and claim payments.
• Accurately documents all calls.
• Recognizes trends and patterns in call types and engages leadership with suggested solutions.
• Accountable to meet and maintain established department production and quality standards, on both an individual and team basis.
• Assists members with navigating the member portal while encouraging them to becoming self-sufficient with our tools.
• Demonstrates personal responsibility and accountability by meeting attendance and schedule adherence expectations.
• Ability to effectively excel in a virtual work environment through active participation in team huddles, Supervisor 1:1s, Instant Messaging, or check-ins.

Experience and Skills Desired

• You have a minimum of 2 years customer service experience.
• You have knowledge of medical and insurance industry terminology including CPT/ICD-10, HCPCS and Revenue Codes.
• You are an excellent communicator, both verbally and in writing and can articulate and communicate complex topics to a broad audience.
• You can perform comfortably in a fast-paced, deadline-oriented work environment.
• You possess strong attention to detail and problem- solving skills with a high level of accuracy.
• You collaborate and support business and operational units such as Claims, Medical Management and Appeals and Grievance.
• You are proficient in Microsoft Office applications Word, Excel, Outlook OneNote, etc.
• You have prior experience using a CRM, preferably SalesForce.
• Bonus: fluency in Spanish.

Telecommuting Requirements

• Required to have a dedicated work area established that is separate from other living areas and provides information privacy.
• Ability to keep all company sensitive documents secure.
• Must live in the United States.
• Must live in a location that receives an existing high-speed internet connection/service.

Location and Benefits

• This is a remote position. Our whole company works remotely.
• Company business hours are weekdays 9-5 CST.
• Full benefits package including health insurance, 401(k) matching, vision, dental, life, disability, and vacation.

Apex Systems is a world-class IT services company that serves thousands of clients across the globe. When you join Apex, you become part of a team that values innovation, collaboration, and continuous learning. We offer quality career resources, training, certifications, development opportunities, and a comprehensive benefits package. Our commitment to excellence is reflected in many awards, including ClearlyRated's Best of Staffing® in Talent Satisfaction in the United States and Great Place to Work® in the United Kingdom and Mexico. Apex uses a virtual recruiter as part of the application process. Click here for more details.

Apex Benefits Overview: Apex offers a range of supplemental benefits, including medical, dental, vision, life, disability, and other insurance plans that offer an optional layer of financial protection. We offer an ESPP (employee stock purchase program) and a 401K program which allows you to contribute typically within 30 days of starting, with a company match after 12 months of tenure. Apex also offers a HSA (Health Savings Account on the HDHP plan), a SupportLinc Employee Assistance Program (EAP) with up to 8 free counseling sessions, a corporate discount savings program and other discounts. In terms of professional development, Apex hosts an on-demand training program, provides access to certification prep and a library of technical and leadership courses/books/seminars once you have 6+ months of tenure, and certification discounts and other perks to associations that include CompTIA and IIBA. Apex has a dedicated customer service team for our Consultants that can address questions around benefits and other resources, as well as a certified Career Coach. You can access a full list of our benefits, programs, support teams and resources within our 'Welcome Packet' as well, which an Apex team member can provide.