Health Insurance Customer Service Representative

Quantum Health is hiring a Health Insurance Customer Service Representative to guide members through their healthcare and benefits journey. In this role, you'll handle inbound calls, explain health insurance coverage, resolve claims and eligibility questions, and coordinate with providers and health plans. You will document interactions accurately, protect member privacy, and escalate complex issues as needed. Working in a collaborative, mission-driven team, you'll use empathy and problem-solving skills to simplify healthcare, improve member experiences, and contribute to better health outcomes.

Responsibilities

• Respond to inbound member calls and messages regarding health insurance benefits, claims, and eligibility
• Explain coverage details, cost-sharing, and plan options in clear, member-friendly language
• Research and resolve claims, billing, and network issues by coordinating with providers and health plans
• Accurately document all member interactions and updates in CRM and related systems
• Protect member privacy and follow HIPAA and company compliance standards
• Identify and escalate complex or urgent issues to appropriate teams for resolution
• Collaborate with teammates and cross-functional partners to improve processes and member experience
• Meet or exceed performance metrics such as quality, responsiveness, and member satisfaction

Required Skills

• Health insurance benefits knowledge
• Call center operations
• Claims and eligibility inquiry handling
• Healthcare terminology
• CRM and ticketing systems
• Data entry and documentation
• De-escalation and conflict resolution
• HIPAA compliance practices
• Multichannel communication (phone/email/chat)
• Basic Microsoft Office skills