Claims Service Representative

We are seeking a Claims Customer Service Representative (Bilingual) for one of our clients over in Brookhaven, Ga. The Claims Customer Service Representative is responsible for handling high-volume inbound calls from policyholders and healthcare providers. This role focuses on resolving claim-related inquiries, providing accurate insurance information, and delivering excellent customer service with an emphasis on first-call resolution.

• Handle a high volume of inbound customer service calls in a professional and efficient manner
• Respond to inquiries related to insurance policies, benefits, coverage, and claims
• Aim for first-call resolution while maintaining a positive customer experience
• Assist healthcare providers with claim processing and submission guidance
• Explain claim adjudication outcomes, reimbursement procedures, and policy details
• Ensure compliance with Medicare, CMS, and industry regulations
• Accurately document all customer interactions and claim-related activity
• Escalate complex or unresolved issues to the appropriate department
• Collaborate with internal teams to support efficient claims and service operations

• Strong knowledge of Medicare Supplement and other applicable insurance products
• Bilingual proficiency in English and Spanish required, with the ability to clearly communicate insurance and claims information to diverse audiences.
• Understanding of healthcare claim adjudication processes
• Experience in a high-volume inbound call environment
• Excellent verbal and written communication skills
• Strong problem‑solving skills and attention to detail
• Ability to work independently and collaboratively within a team
• Proficiency with customer service systems, databases, and related tools
• Education- High school diploma or equivalent
• Empathy and patience with customers and providers
• Clear and effective communication
• Time management and multitasking in a fast‑paced environment
• Attention to accuracy and documentation
• Adaptability to changing policies, guidelines, and procedures

Equal Opportunity Employer/Veterans/Disabled

To read our Candidate Privacy Information Statement, which explains how we will use your information, please navigate to

• The California Fair Chance Act
• Los Angeles City Fair Chance Ordinance
• Los Angeles County Fair Chance Ordinance for Employers
• San Francisco Fair Chance Ordinance

Benefit offerings include medical, dental, vision, life insurance, short-term disability, additional voluntary benefits, EAP program, commuter benefits, and 401K plan. Our program provides employees the flexibility to choose the type of coverage that meets their individual needs. Available paid leave may include Paid Sick Leave, where required by law; any other paid leave required by Federal, State, or local law; and Holiday pay upon meeting eligibility criteria.