Call Center Customer Service Representative

Job Description

The Customer Service Representative (CSR) – Entry Level supports inbound and outbound calls, assisting providers and beneficiaries with basic health insurance and prior authorization inquiries. This role is designed for individuals new to healthcare administration who are building foundational knowledge of payer operations under close supervision.

• Answer inbound calls in a professional, empathetic, and compliant manner
• Provide basic information related to:
  • Prior authorization status
  • Program participation and routing
  • General Medicare Part B processes
• Accurately document calls, interactions, and outcomes in designated systems
• Escalate clinical, complex, or policy-based questions to senior representatives or supervisors
• Follow established call scripts, workflows, and compliance guidelines
• Participate in required training related to CMS, Medicare, and operations
• Meet performance expectations for call quality, accuracy, and timeliness

• Fundamentals of health insurance and Medicare
• Basic prior authorization concepts and terminology
• Call center compliance standards (HIPAA, CMS guidelines)
• Program structure and escalation pathways

• High school diploma or equivalent (associate or bachelor’s degree preferred)
• 0–2 years of experience in customer service or healthcare administration
• Strong communication skills and willingness to learn complex topics
• Comfort using multiple systems while on live calls
• Ability to follow structured workflows and escalation protocols