Health Insurance Customer Service Representative

Quantum Health is seeking a Health Insurance Customer Service Representative to support members in navigating their healthcare and benefits. In this role, you'll answer inbound calls, explain health plan coverage, resolve claims and billing questions, and coordinate with providers, payers, and internal clinical teams. You'll use multiple systems to research benefits, document interactions, and escalate complex issues. Working in our collaborative, mission-driven environment, you'll deliver compassionate, accurate, and efficient service that improves the healthcare experience for members while contributing to continuous process and service improvements.

Responsibilities

• Answer inbound member calls and provide clear, compassionate support on benefits and healthcare navigation
• Explain health insurance coverage, eligibility, copays, and prior authorizations in plain language
• Research and resolve claims, billing, and network issues using multiple internal systems
• Coordinate with providers, payers, and internal clinical and service teams to resolve member concerns
• Document all member interactions accurately and follow established procedures and compliance requirements
• Escalate complex, clinical, or high-impact issues to appropriate teams for resolution
• Meet or exceed quality, accuracy, and productivity metrics in a fast-paced call center environment
• Protect member privacy and maintain HIPAA and data security standards
• Identify trends in member issues and share feedback to improve processes and member experience
• Participate in training, coaching, and continuous learning to stay current on plan updates and tools

Required Skills

• Health insurance and medical benefits knowledge
• Claims and billing research
• Call center systems and CRM tools
• Data entry and documentation accuracy
• De-escalation and conflict resolution
• HIPAA and privacy compliance awareness
• Multitasking across multiple systems
• Professional verbal and written communication
• Problem-solving and issue resolution
• Basic Microsoft Office and computer navigation