Client Support Representative

Job Title:

Client Support Representative (AI Patient Access Specialist)

Job Description

The Client Support Representative serves as an AI Patient Access Specialist in a next-generation contact center role within the healthcare field. In this position, you monitor AI-led conversations between healthcare representatives and insurance agents, guide the AI by selecting accurate prompts and next steps, and seamlessly take over calls when human interaction is required. You play a critical role in insurance verification and prior authorization follow-up while maintaining thorough documentation and ensuring all information is accurately captured in internal systems.

Responsibilities

+ Monitor AI-led agent-to-agent conversations between healthcare representatives and insurance agents to ensure accuracy and continuity.

+ Drive AI interactions by selecting appropriate prompts, questions, and next steps to help the AI navigate complex healthcare reimbursement scenarios.

+ Take over calls when the AI cannot proceed, when agents prefer to speak with a human, or when carrier or contract requirements mandate human interaction.

+ Review notes from existing conversations and quickly pick up where another specialist or the AI left off, maintaining a seamless experience for all parties.

+ Ensure continuity and accuracy throughout each interaction by confirming details and clarifying information as needed.

+ Verify insurance eligibility, benefits, and coverage details for patients and healthcare providers.

+ Gather and document prior authorization information and conduct follow-up activities with insurance agents to complete outstanding tasks.

+ Capture complete and accurate insurance verification and authorization information before concluding each call.

+ Maintain detailed notes during and after conversations, documenting all relevant insurance verification and prior authorization details.

+ Update internal systems with comprehensive and accurate information from each interaction.

+ Review documentation for completeness and accuracy before closing workflows or interactions.

+ Manage both outbound and inbound call workflows while maintaining high levels of quality, accuracy, and professionalism.

+ Handle a typical call volume of approximately 10-20 calls per day, including shorter calls of about 5 minutes and more complex insurance verification calls that may last 30-45 minutes.

+ Work on one AI-supported conversation at a time to ensure focused attention and precise documentation.

+ Follow established processes and workflows while contributing to process improvement by identifying opportunities to enhance efficiency and accuracy.

+ Collaborate effectively with AI-driven technology as the human-in-the-loop, helping teach the system how to navigate the complexities of healthcare reimbursement.

+ Provide a high level of customer service and professionalism in all interactions with insurance agents and healthcare representatives.

+ Quickly absorb information from previous notes and continue conversations seamlessly without missing critical details.

Essential Skills

+ High School Diploma or GED.

+ Basic computer proficiency and ability to learn new systems and technology.

+ Proven data entry and documentation skills with strong accuracy and attention to detail.

+ Experience navigating multiple systems and screens simultaneously.

+ Customer service experience of at least 6 months.

+ Strong attention to detail when reviewing and entering information.

+ High level of customer service and professionalism in phone-based interactions.

+ Solution-oriented mindset with the ability to resolve issues and move conversations forward.

+ Ability to work independently while following established workflows and processes.

+ Ability to follow directions and adhere to standardized procedures.

+ Strong listening, comprehension, and verbal communication skills.

+ Ability to quickly absorb information from previous notes and continue a conversation seamlessly.

+ Coachable attitude and adaptability to new technology, AI tools, and evolving workflows.

+ Comfort working in healthcare-related environments, including insurance verification and prior authorization support.

+…