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  • Serves as the primary point of contact for members and providers, managing inbound and outbound calls and emails with professionalism.
  • Researches and resolves inquiries on benefits, eligibility, claims, and billing to ensure first-contact resolution and meet department metrics.
  • Supports escalation intake, collaborates with internal teams, and assists members with portal navigation to promote digital self-sufficiency.

Customer Service Claims Processing Microsoft 365 Salesforce

20 jobs similar to Commercial Health Call Center Representative

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$35,000–$40,000/yr
US

  • Provide support to participants and clients regarding eligibility, benefits, claims, and general plan inquiries via phone and email.
  • Document all customer interactions accurately in the call tracking system and navigate multiple systems to assist customers.
  • Maintain confidentiality in accordance with HIPAA standards and contribute to a positive, team-oriented environment.

Point C is a National third-party administrator that delivers customized self-funded benefit programs. They are a mission-driven company focused on innovative cost containment strategies.

Global Unlimited PTO 16w maternity 16w paternity

  • Serve as first point of contact for members and providers via phone and email, resolving health insurance inquiries.
  • Use active listening and empathy to understand issues, explain benefits, claims, and coverage, and document interactions.
  • Maintain a structured schedule, with availability during peak season, and uphold the Gravie CARE service model and core values.

Gravie creates innovative health benefits for small and midsize businesses, focusing on solutions that genuinely benefit employees. The company is well-funded, non-hierarchical, and merit-driven, with a culture that values authenticity, curiosity, and creativity.

US

  • Provide efficient, courteous service to members, providers, and other customers via phone, email, and more.
  • Resolve routine and moderately complex inquiries about enrollment, billing, benefits, claims, and other topics.
  • Research inquiries, interpret policies, and ensure accurate, timely responses to meet customer satisfaction.

Capital Blue Cross is an independent licensee of the Blue Cross Blue Shield Association providing health insurance and related services. They value a flexible, supportive work culture and prioritize employee growth, consistently being voted one of the “Best Places to Work in PA.”

US

  • Provide professional and timely service to internal and external customers regarding benefit administration.
  • Resolve benefit service issues with internal staff and outside vendors.
  • Perform monthly reconciliation of Carrier invoices to report to customers.

OneSource Virtual (OSV) works exclusively with Workday customers to automate payroll, taxes, earned wage access, accounts payable, and benefits. With over 1,500 customers and 92% retention, OSV offers a values-based culture and professional development.

US

  • Provide Level III customer service through phone, chat, email, and administrative channels supporting multiple healthcare products and states.
  • Research and resolve complex member and provider issues involving eligibility, benefits, claims, premiums, authorizations, appeals, contracting, credentialing, and related matters.
  • Handle escalated and highly complex calls, including issues raised on behalf of leadership, while applying appropriate risk-based escalation protocols.

The company delivers customer support solutions for healthcare members and providers across multiple lines of business. It operates as a partner organization with a large, remote team focused on high-volume, fast-paced support.

US

  • Answer inbound calls, schedule appointments, and provide excellent customer service in a centralized access center environment.
  • Verify and update patient demographics, insurance, and electronic health records while maintaining confidentiality.
  • Adhere to call quality and scheduling guidelines, achieving minimum call standards and 95%+ quality threshold.

This is a physician-led, patient-centric network simplifying healthcare with primary, multispecialty, and urgent care services. They serve millions of patients across traditional practices, homes, and virtually, fostering a compassionate and innovative community.

US

  • Serve as primary point of contact for clients, managing inbound/outbound communications with professional excellence.
  • Resolve inquiries via phone, email, chat, or social media, de-escalating issues and escalating when necessary.
  • Track call information for auditing and reporting, and upsell if required.

TP is a leading global provider of digital business services, partnering with prominent brands to optimize operations through advanced technology and sustainable practices. With a global workforce of 500,000 across 300 languages, TP fosters a culture of inclusion, diversity, and career growth.

$15–$22/hr
US

  • Deliver a respectful, compassionate experience for every caller, aiming for one-call resolution.
  • Complete crisis screening assessments and coordinate with crisis teams when immediate intervention is needed.
  • Manage and track referrals in Salesforce, including conducting outbound follow-up calls.

Centerstone is a nonprofit behavioral health system providing mental health and substance use disorder treatments. With thousands of employees, it is a dynamic, well-established organization focused on delivering care that changes people's lives.

US

  • Handle inbound and outbound calls to schedule no-cost In-Home Health Assessments, engaging members professionally and identifying their needs.
  • Use active listening, empathy, and strong communication to address concerns, de-escalate difficult interactions, and guide callers to appropriate solutions.
  • Meet performance metrics, follow call scripts and procedures, and accurately document interactions using contact center software and databases.

This partner company connects members with no-cost In-Home Health Assessments through a remote contact center. The team is target-driven and service-oriented, offering a flexible remote work environment with ongoing training and support.

US

  • Respond to inbound and outbound calls to address customer inquiries about benefits and claims in a polite manner.
  • Forward inquiries as directed for priority resolution and document each encounter in the tracking system.
  • Multi-task in several computer applications while holding a conversation with a customer.

We are focused on delivering engaging interactions and positive experiences that leave a lasting impression. We are an equal opportunity employer committed to creating job opportunities and helping people pursue their total vocation.

US

  • Handle high-volume inbound calls to schedule appointments and present offers.
  • Overcome patient objections and use product knowledge to showcase dental solutions.
  • Manage sensitive information and consistently meet key performance indicators.

North American Dental Group (NADG) uses its individuality and expertise to work with partnered dental offices to provide best-in-class patient care. The company's guiding principle is empathy, and it focuses on putting every patient first, every visit.

US

  • Handle inbound calls efficiently, schedule/reschedule appointments, and complete daily administrative tasks for the Call Center support team.
  • Provide excellent customer service with a professional, confidential work ethic and knowledge of HIPAA regulations.
  • Work remotely from approved states (PA, MD, VA, DC, FL, GA) with reliable internet and a quiet dedicated space.

Vision Innovation Partners exists to protect and restore vision. The company offers a culture centered on its Shared Values – PATIENTS, with opportunities for growth and development.

US

  • Connect with customers via phone, email, chat, or social media to resolve their questions or concerns.
  • Calmly resolve and de-escalate any issues while escalating interactions when necessary.
  • Track all call-related information for auditing and reporting purposes.

TP is a leading global provider of digital business services, partnering with prominent brands to optimize operations through technology and sustainable practices. With a global workforce of 500,000 across 300 languages, we are committed to being a force for good in communities and for our clients.

US

  • Answer inbound calls from Medicare Advantage members and providers with empathy and professionalism.
  • Handle inquiries regarding benefit eligibility, enrollment, and claims status while conducting thorough research.
  • Navigate multiple systems to resolve issues and advocate for members, ensuring first-call resolution.

Johns Hopkins Health Plan provides health insurance services to members. It is part of the Johns Hopkins Health System, a large organization with a diverse team of healthcare professionals.

US

  • Support customers over the phone with product information and account corrections.
  • Ensure accuracy and completeness of customer paperwork and records.
  • Resolve product or service problems by clarifying complaints and providing solutions.

Five Star Solutions provides customer support services for the firearms industry. The company is an equal opportunity employer committed to cultivating a professional, diverse workforce.

US

  • Serve as primary point of contact for clients, managing inbound and outbound communications to resolve inquiries via phone, email, chat, or social media.
  • Calmly de-escalate issues, escalate when necessary, and track call information for auditing and reporting purposes.
  • Provide feedback on call issues and upsell when appropriate to ensure a positive customer experience.

TP is a leading global provider of digital business services, partnering with prominent brands to optimize operations through advanced technology and sustainable business practices. With a global workforce of 500,000 across 300 languages, TP prioritizes a culture of inclusion and diversity with limitless career advancement.

US

  • Conduct educational telephone calls to advise members of benefits, complete health needs assessments, and refer to population health management programs.
  • Reach out to members with gaps in care, encourage compliance, and assist with locating providers and scheduling appointments.
  • Manage system work queues, screen members for eligibility and history, and assign to clinical teams for intervention.

BlueCross BlueShield of Tennessee is the state's largest health benefit plan company, helping Tennesseans find paths to good health since 1945. They are a remote-first organization with many employees working from home, fostering a culture of innovation and collaboration.

US

  • Deliver exceptional customer service in a fast-paced call center environment, managing patient registration, scheduling, and provider communications.
  • Handle inbound and outbound calls and emails with empathy and solution-focused support while navigating multiple systems.
  • Accurately collect and document patient demographics, insurance, and appointment details, adapting to changing processes and technology.

Luna redefines physical therapy with award-winning technology and proven clinical models, connecting patients and providers through a tech-enabled platform. Operating in 28 states with 25+ partners, the company values care, impact, and continuous improvement.

US

  • Manage multiple channel interactions professionally and efficiently.
  • Address provider inquiries with accuracy and focus on first call resolution.
  • Maintain positive relationships and exceed quality and productivity goals.

Capital Blue Cross is an independent licensee of the Blue Cross Blue Shield Association focused on improving the health and well-being of its members and communities. It has been consistently voted one of the Best Places to Work in PA and fosters a flexible, supportive culture with emphasis on professional growth and community involvement.

US

  • Answer inbound calls and make outbound calls to create sales opportunities for the retail sales team.
  • Qualify customers for the reverse mortgage program using scripted guidelines and transfer interested leads.
  • Update the sales CRM with notes and schedule follow-up appointments to maintain the pipeline.

Longbridge Financial provides home equity solutions for seniors, helping them access their home equity for retirement. With an "Excellent" Trustpilot rating and over a thousand testimonials, they've been named a Great Place to Work three years running, fostering a supportive and growth-oriented culture.