Customer Service Representative

Quantum Health is seeking a Customer Service Representative to guide members through their healthcare journey. In this role, you'll answer inbound calls, explain benefits, coordinate care, and connect members with providers and internal clinical teams. You'll research claims, resolve issues, document interactions in our systems, and escalate complex cases when needed. Working in a collaborative, mission-driven culture, you'll deliver empathetic, accurate support, helping simplify healthcare while developing your skills in customer service, healthcare navigation and technology.

Responsibilities

• Answer inbound member calls and provide clear, empathetic support
• Explain healthcare benefits, coverage, and claims status
• Coordinate care by connecting members with providers and internal teams
• Research and resolve benefit, billing, and claims issues
• Accurately document all member interactions in internal systems
• Escalate complex or urgent issues to appropriate specialists
• Follow HIPAA and privacy guidelines in all communications
• Contribute to team goals and continuous process improvement

Required Skills

• Customer service
• Call center systems
• CRM software
• Healthcare benefits knowledge
• Medical terminology basics
• Data entry
• De-escalation techniques
• Active listening
• Written and verbal communication
• Problem-solving