Customer Service Representative

Customer Service Representative

This is a fully in-office, member-facing bilingual Customer Service Representative position supporting Culinary Health Fund members. In this role, you will serve as a key resource for members and providers, delivering high-quality, timely support across a range of inquiries including benefits, eligibility, claims, and appeals. You will be responsible for handling customer interactions across multiple channels—including phone, email, and chat—based on business needs, while ensuring an exceptional service experience.

This role requires strong communication skills, attention to detail, and the ability to navigate complex and sometimes escalated situations with professionalism and empathy. This is a bargaining unit position represented by POPA.

Primary Responsibilities

• Provide timely and professional support to members and providers regarding benefits, eligibility, claims, and appeals
• Will be required to handle customer service inquiries via the contact center phones, email, and chat depending on business needs.
• Handle escalated customer concerns and complaints
• Assist with Claims processing.
• Collaborate with the Benefits Enrollment team to resolve eligibility, hours, and co-premium inquiries, proactively following up with members as needed.
• Actively listen to customer concerns, demonstrating empathy and offering effective solutions.
• Analyze and resolve non-standard and complex issues using critical thinking and problem-solving skills.
• Maintain a strong understanding of client products, services, and policies to provide accurate and informed assistance.
• Document all interactions and resolutions accurately in the system to ensure seamless customer service.
• Adhere to regulatory requirements, company policies, and confidentiality guidelines when handling member information.

Essential Qualifications

• Bilingual Preferred (English / Spanish)
• Prior customer service experience serving unions preferred.
• Prior customer service experience in a high-volume call center, preferably in healthcare, insurance, or a related field is required.
• Experience with claims inquiry and claims review procedures, knowledge of medical specialties, fee schedules, complaints and appeals and call center responsibilities required.
• Strong communication skills with the ability to explain complex information in a clear and empathetic manner.
• Ability to manage multiple inquiries while maintaining attention to detail and accuracy.
• Problem-solving skills and the ability to navigate complex eligibility and claims issues.
• Effective communication through various channels, including email, chat, and voice
• Salesforce experience preferred.
• Intermediate proficiency in Microsoft Office (Word, Excel, Outlook).