Call Center Representative

Job Title:

Call Centre Representative

Job Description

This role focuses on providing high-quality support to patients, healthcare providers, insurance companies, and third-party partners within a busy call centre environment. You handle predominantly outbound, back-to-back calls, resolving coverage and prescription-related queries while delivering professional, compassionate, and efficient customer service. You play a key role in navigating insurance processes, supporting authorisations, and helping patients access financial assistance programmes.

Responsibilities

+ Serve as the primary point of contact for patients, healthcare providers, insurance companies, and third-party partners via phone and email.

+ Manage high volumes of outbound calls, often back to back, while also handling inbound calls related to coverage, benefits, and prescription enquiries.

+ Conduct detailed insurance benefit investigations and verify both medical and pharmacy coverage.

+ Support prior authorisation requests, appeals, and medical exception processes to facilitate timely access to medications and services.

+ Assist patients with enrolment in manufacturer-sponsored financial assistance programmes and other available support resources.

+ Research and resolve insurance claim rejections, coverage issues, and related queries, ensuring clear communication of outcomes to patients and partners.

+ Submit, track, and follow up on authorisation requests, proactively driving them to timely approval and resolution.

+ Maintain accurate, thorough documentation of all interactions and actions taken, in line with company procedures and regulatory requirements.

+ Use multiple systems and tools, including Microsoft Office, Microsoft Teams, Scriptly, email, and call centre platforms, to manage work efficiently.

+ Deliver a high standard of customer service, providing white glove treatment and demonstrating empathy while maintaining professional boundaries.

+ Apply active listening skills to understand patient and partner needs, ask clarifying questions, and provide clear, concise information.

+ Multi-task effectively by navigating systems, entering data, and managing calls simultaneously in a fast-paced environment.

+ Adapt quickly to shifting priorities, different call types, and changes in processes or schedules.

+ Respond positively to feedback, using it to improve performance and contribute to overall team quality scores.

+ Meet and maintain key performance indicators, including adherence, attendance, and quality standards.

+ Collaborate with internal partners and colleagues, using strong communication skills to ensure smooth handovers and consistent service.

+ Follow established scripts and guidelines where appropriate, while tailoring communication to individual patient needs.

+ Uphold all company policies and compliance requirements in every interaction, protecting patient information and maintaining professional conduct.

Essential Skills

+ Proven experience in a call centre or customer service role, handling phone-based enquiries.

+ High school diploma or equivalent qualification.

+ Strong verbal and written communication skills, suitable for interacting with patients, providers, insurance representatives, and internal partners.

+ Excellent customer service skills, with the ability to provide professional and compassionate support.

+ Ability to manage multiple tasks at once and remain effective in a fast-paced, high-volume environment.

+ Confidence in speaking with a wide range of stakeholders, including patients, healthcare professionals, and insurance contacts.

+ Solid computer literacy, including the ability to navigate multiple systems and applications during calls.

+ Accurate data entry skills and attention to detail when documenting interactions and processing information.

+ Ability to work full-time, 40 hours per week, onsite within the specified shift patterns.

+ Strong active listening skills and the ability to respond appropriately to complex or sensitive situations.

+ Capacity to multi-task, shift focus quickly, and handle back-to-back calls without compromising quality.

+ Openness to feedback and willingness to adjust behaviours and approaches to improve performance.

+ Adaptability to changing schedules, processes, and priorities within the call centre environment.

Additional

Skills & Qualifications

+ Experience in healthcare, pharmacy, insurance, or a related call centre environment is beneficial but not essential.

+ Familiarity with outbound calling and managing…