We are seeking a Claims Customer Service Representative for one of our clients in Brookhaven, GA. The Claims Customer Service Representative is responsible for handling high-volume inbound calls from policyholders and healthcare providers. This role focuses on resolving claim-related inquiries, providing accurate insurance information, and delivering excellent customer service with an emphasis on first-call resolution.
Key Responsibilities
Handle a high volume of inbound customer service calls in a professional and efficient manner
Respond to inquiries related to insurance policies, benefits, coverage, and claims
Aim for first-call resolution while maintaining a positive customer experience
Assist healthcare providers with claim processing and submission guidance
Explain claim adjudication outcomes, reimbursement procedures, and policy details
Ensure compliance with Medicare, CMS, and industry regulations
Accurately document all customer interactions and claim-related activity
Escalate complex or unresolved issues to the appropriate department
Collaborate with internal teams to support efficient claims and service operations
Required Qualifications
Strong knowledge of Medicare Supplement and other applicable insurance products
Understanding of healthcare claim adjudication processes
Experience in a high-volume inbound call environment
Excellent verbal and written communication skills
Strong problem-solving skills and attention to detail
Ability to work independently and collaboratively within a team
Proficiency with customer service systems, databases, and related tools
Education- High school diploma or equivalent
Preferred Qualifications
Skills & Competencies
Customer service excellence
Empathy and patience with customers and providers
Clear and effective communication
Time management and multitasking in a fast-paced environment
Attention to accuracy and documentation
Adaptability to changing policies, guidelines, and procedures
Location: Brookhaven, GA
Job Type: Onsite | Direct Hire | Full-Time
Pay Details: $50,000.00 to $53,000.00 per year
Search managed by: Coleman Harris
Equal Opportunity Employer/Veterans/Disabled
Military connected talent encouraged to apply
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