**Experienced Customer Service Representative – Healthcare Insurance and Call Center Expertise**

Are you passionate about delivering exceptional customer experiences and making a meaningful impact in the lives of others? Do you thrive in fast-paced, dynamic environments where no two interactions are ever the same? If so, we invite you to join the blithequark team as an Experienced Customer Service Representative, where you'll have the opportunity to leverage your skills and expertise to champion for the best health of our members. **About blithequark** At blithequark, we're dedicated to revolutionizing the healthcare industry by providing innovative solutions that empower individuals to take control of their well-being. Our team is comprised of passionate professionals who share a common goal: to make a positive difference in the lives of our members. As a Customer Service Representative, you'll be an integral part of this mission, working closely with our members, providers, and plan sponsors to resolve issues, answer questions, and provide guidance on our healthcare plans and policies. **Responsibilities** As an Experienced Customer Service Representative, you'll be responsible for: * Answering questions and resolving issues based on phone calls/letters from members, providers, and plan sponsors, triaging results to ensure efficient resolution * Documenting and tracking contacts with members, providers, and plan sponsors, guiding members through their plan of benefits, client policy, and procedures while ensuring compliance with regulatory guidelines * Creating an emotional connection with our members by understanding and engaging with them to champion for their best health * Taking accountability to fully understand member needs by building trusting and caring relationships * Anticipating customer needs and providing related information to answer unasked questions * Using the customer service threshold framework to make financial decisions to resolve member issues * Explaining members' rights and responsibilities by contract * Processing claim referrals, new claim handoffs, nurse reviews, complaints (member/provider), grievance, and appeals (member/provider) via the target system * Educating providers on our self-service options and assisting with credentialing and recredentialing issues * Responding to requests from the Client's Law Document Center regarding litigation and lawsuits * Handling extensive file review requests * Assisting in the preparation of complaint trend reports and compiling claim data for customer audits * Determining medical necessity, applicable coverage provisions, and verifying member plan eligibility for incoming correspondence and internal referrals * Handling incoming requests for appeals and pre-authorizations not handled by Clinical Claim Management * Reviewing member claim history to ensure accurate tracking of benefit maximums and/or coinsurance/deductible, performing financial data maintenance as necessary **Qualifications** To be successful in this role, you'll need: * High School or GED equivalent * Customer Service experience in a transaction-based environment, such as a call center or retail location, demonstrating ability to be empathetic and compassionate * Experience in a production environment * Healthcare insurance and call center experience is preferred **Skills and Competencies** To excel as an Experienced Customer Service Representative, you'll need: * Excellent communication and interpersonal skills, with the ability to build trust and rapport with members, providers, and plan sponsors * Strong problem-solving and analytical skills, with the ability to navigate complex healthcare policies and procedures * Ability to work in a fast-paced, dynamic environment with multiple priorities and deadlines * Proficiency in using technology, including CRM systems and other software applications * Strong attention to detail and organizational skills, with the ability to maintain accurate records and documentation * Ability to work independently and as part of a team, with a focus on collaboration and continuous improvement **Career Growth Opportunities and Learning Benefits** At blithequark, we're committed to helping our employees grow and develop their careers. As an Experienced Customer Service Representative, you'll have access to: * Ongoing training and development opportunities, including workshops, webinars, and coaching * Mentorship and guidance from experienced professionals in the field * Opportunities for advancement and career growth within the company * A dynamic and supportive work environment that encourages collaboration and innovation **Work Environment and Company Culture** Our office is a vibrant and inclusive space that fosters creativity, collaboration, and growth. As an Experienced Customer Service Representative, you'll be part of a team that values: * Diversity, equity, and inclusion * Continuous learning and professional development * Open communication and feedback * Work-life balance and flexibility * Community involvement and social responsibility **Compensation, Perks, and Benefits** We offer a competitive compensation package, including: * Salary: $ [insert salary range] * Benefits: [insert benefits, such as health insurance, retirement plan, paid time off, etc.] * Perks: [insert perks, such as flexible work arrangements, employee discounts, etc.] **How to Apply** If you're passionate about delivering exceptional customer experiences and making a meaningful impact in the lives of others, we invite you to apply for this exciting opportunity. Please submit your resume and cover letter to [insert contact information]. We can't wait to hear from you! **Equal Opportunity Employer** blithequark is an equal opportunity employer, committed to diversity, equity, and inclusion. We welcome applications from qualified candidates of all backgrounds and perspectives.