Experienced Customer Service Representative - Remote Opportunity with blithequark

Join blithequark and Make a Difference in Healthcare

At blithequark, we're driven by a singular, clear purpose: to bring our heart to every moment of your health. Our mission is to deliver enhanced, human-driven healthcare in a rapidly changing world. With a focus on making healthcare more personal, convenient, and affordable, we're committed to making a positive impact on the lives of our members.

About the Role

We're seeking an experienced Customer Service Representative to join our team at blithequark. As the face of our organization, you'll play a critical role in shaping the member experience through your interactions with individuals, providers, and plan sponsors. Your expertise and empathy will help resolve complex issues, address inquiries, and provide personalized support to our members.

Key Responsibilities

• Respond to member inquiries and resolve issues via phone, web, or written correspondence in a timely and professional manner.
• Engage with members to understand their unique needs, preferences, and understanding of blithequark plans, tools, and resources.
• Guide members through their benefit plans, blithequark policies, and procedures, ensuring compliance with regulatory guidelines.
• Build trusting relationships with members by being empathetic, understanding, and proactive in addressing their concerns.
• Utilize customer service skills to make informed decisions that resolve member issues efficiently.
• Process claims, new case handoffs, nurture reviews, complaints, and requests via our target system.
• Educate providers on our self-service options and assist with credentialing and re-credentialing issues.
• Respond to demands from blithequark's Litigation Record Place regarding litigation and claims.
• Assist in preparing complaint pattern reports and integrating claim data for client reviews.
• Determine medical necessity, relevant coverage policies, and verify member eligibility for services.
• Handle incoming requests for appeals and pre-approvals not handled by Clinical Case Management.
• Perform reviews of member claim history to ensure accurate tracking of benefit maximums and coinsurance/deductible.
• Provide financial data support as needed.
• Utilize relevant system tools and resources to generate quality letters and calculation sheets in response to requests received.

Essential Qualifications

To succeed in this role, you'll need:

• A Bachelor's degree from an accredited institution.
• Customer service experience in a transaction-based environment, such as a call center or retail store.
• Excellent communication and interpersonal skills, with the ability to be empathetic and compassionate.
• Strong problem-solving and analytical skills.
• Proficiency in Microsoft Word and Outlook.
• Ability to multitask and maintain accuracy and productivity standards.
• Technical skills and adaptability to new systems and tools.

Preferred Qualifications

While not required, the following qualifications will give you a competitive edge:

• Experience in a healthcare or insurance setting.
• Knowledge of medical terminology.
• Previous experience working in a fast-paced, dynamic environment.

What We Offer

At blithequark, we offer a comprehensive benefits package, including:

• Competitive hourly rate: $30-$41 per hour.
• Medical, dental, and vision benefits.
• 401(k) retirement savings plan and Employee Stock Purchase Plan.
• Term life insurance and short-term and long-term disability benefits.
• Wellness programs, education assistance, and free improvement courses.
• CVS store discount and rebate programs with participating partners.
• Paid Time Off (PTO) and holidays throughout the calendar year.

Career Growth and Development

At blithequark, we're committed to helping you grow and develop in your career. You'll have access to training and development opportunities, as well as the chance to work with a talented team of professionals who are passionate about delivering exceptional healthcare experiences.

Our Culture

Our Heart At Work Behaviors guide our actions and decisions, ensuring that we're always putting our members first. We're a diverse and inclusive organization that values empathy, compassion, and integrity. If you're passionate about making a difference in healthcare and want to be part of a dynamic team, we encourage you to apply.

Preparing for Your Interview

To help you prepare for your interview, we've put together some common questions and tips:

• Be ready to talk about your experience and skills relevant to the role.
• Highlight your strengths and the qualities that make you a strong candidate.
• Be honest about your weaknesses and how you're working to improve them.
• Show your passion for delivering exceptional customer service and making a difference in healthcare.
• Come prepared with questions to ask us about the role, our culture, and opportunities for growth and development.

If you're a motivated and compassionate professional looking for a challenging and rewarding role, we encourage you to apply to this exciting opportunity with blithequark. Join our team and help us make a positive impact on the lives of our members.