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 the member through their individual plan of benefits, blithequark policy, and procedures, as well as being aware of resources to comply with any regulatory requirements. Make a personal connection with our members by understanding and engaging the member to the fullest to support our members' 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 assist 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 trend 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 required. 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 with 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 Previous 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. Certification in customer service or a related field. 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 to enhance your skills and knowledge. You will also have opportunities to advance your career within the company, whether it's moving into a specialized role or taking on a leadership position. Work Environment and Company Culture Our company culture is built on the principles of empathy, compassion, and a commitment to delivering exceptional customer service. We believe in creating a work environment that is supportive, inclusive, and respectful of all employees. As a remote employee, you will be part of a virtual team that is connected through technology and shared goals. Compensation, Perks, and Benefits We offer a competitive salary range 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. blithequark offers a full range of medical, dental, and vision benefits, as well as a 401(k) retirement savings plan, employee stock purchase plan, and paid time off. Conclusion If you are a motivated and compassionate individual who is passionate about delivering exceptional customer 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 making a positive impact on the lives of our members. Don't miss out on this chance to be part of a dynamic and growing organization that is dedicated to making a difference in the healthcare industry. Apply for this job