Customer Service Representative

Quantum Health seeks a Customer Service Representative to serve as a Healthcare Navigator, guiding members through complex healthcare systems. In this full-time role, you'll handle inbound calls, explain benefits, resolve billing and claims issues, and coordinate care with providers and insurers. You'll use CRM tools, follow HIPAA and quality standards, and collaborate with clinical teams to ensure members receive timely support.

Quantum Health offers a caring, inclusive culture focused on wellness and empowerment, where your work directly improves patients' healthcare experiences while helping lower costs.

Responsibilities

• Serve as primary point of contact for members seeking help with healthcare benefits and services
• Educate and guide patients through insurance coverage, provider options, and care pathways
• Handle high-volume inbound calls, emails, and online inquiries with empathy and professionalism
• Research and resolve billing, claims, and authorization issues by coordinating with providers and payers
• Document all member interactions accurately in CRM and case management systems
• Collaborate with clinical and support teams to ensure timely, coordinated care
• Escalate complex or urgent member issues following established protocols
• Meet or exceed quality, compliance, and productivity targets
• Protect member privacy and maintain HIPAA and data security standards
• Contribute to a positive, inclusive, wellness-focused team culture

Required Skills

• Healthcare customer service
• Health insurance and benefits knowledge
• Medical terminology
• Claims and billing inquiry resolution
• CRM and call center software proficiency
• Data entry and documentation accuracy
• HIPAA compliance and privacy practices
• Problem solving and critical thinking
• Professional verbal and written communication
• Conflict resolution and de-escalation