CSR II - Contract

Ask appropriate questions and listen actively to identify specific questions or issues to provide appropriate response and type of assistance the customer needs while documenting relevant information in a clear and concise manner in computer systems. Communicate and partner with customers tactfully and empathetically to resolve issues, using clear language translating healthcare-related jargon and complex processes into simple, step-by-step instructions customers can comprehend and act upon.

Job Description - EAS CSO - CSR II (2026)

Training Schedule:
Start Date: Tuesday, September 8th

Training Hours: 9:00 AM 5:30 PM EST
Welcome Week Dates 9/8-9/10

Production Schedule: 9:00 AM 5:30 PM EST or 9:30 AM 6:00 PM EST (30-minute lunch)

Our customer service team offers candidates the opportunity to make a meaningful impact by providing exceptional support to our valued customers, fostering a sense of job satisfaction through problem-solving and positive interactions. Our team values collaboration, continuous learning, and a customer-centric approach, ensuring that every team member contributes to providing better health outcomes.

Leadership rewards and recognizes CSR's regularly for performance in an environment that challenges while providing clear direction and support to foster success in the role.

Customer Service Representatives (CSR's) are the first point of contact for our members and healthcare providers. They assist with inquiries, provide information about member eligibility and benefits, as well resolve any emerging problems that the member and/or provider face with accuracy and efficiency.

Job Responsibilities

• Answer and manage inbound inquiries regarding health plan benefits and claims, eligibility, medical and other healthcare procedures, billing and payments and other related topics from customers in a prompt, courteous manner. Conduct out-bound and/or return calls to customers as necessary.
• Ask appropriate questions and listen actively to identify specific questions or issues to provide appropriate response and type of assistance the customer needs while documenting relevant information in a clear and concise manner in computer systems.
• Communicate and partner with customers tactfully and empathetically to resolve issues, using clear language translating healthcare-related jargon and complex processes into simple, step-by-step instructions customers can comprehend and act upon.
• Handle and process customer complaints/ grievances while applying appropriate conflict management skills to de-escalate potentially stressful situations.
• Meet the performance goals established for the position in the areas of efficiency, accuracy, quality, member satisfaction and attendance. Adhere to all applicable department, organization and/or regulatory policies and procedures.
• Read, comprehend, and verbalize processes and procedures of the organization and of health insurance coverage.
• Training includes a virtual classroom environment with trainers who have experience working within the Evolent Customer Service Operations (CSO) call center. Training Hours are 8:00am - 4:30pm CT Monday-Friday (for approximately 6-weeks). Trainees will be required to attend the entirety of training, successfully complete the required training schedule, and demonstrate proficiency of the material at the end of training.
• Hours of Operation: 6 days a week, 8:00am - 9:00pm ET {hours depend on the client to which you are assigned, and your shift will be determined during training if not before).
• Accurately document customer interactions and transactions using the company's CRM system.

Job History Experience, Qualification and Skills:

• Bilingual in Spanish & English (validated via bilingual assessment upon offer acceptance) is a plus.
• Customer Service Experience: At least 1-2 years of experience in a customer service role, preferably in a healthcare setting.
• Healthcare Knowledge: Familiarity with healthcare and medical terminologies, as well as an understanding of health plan benefits and patient eligibility.
• Call Center Experience: Experience working in a call center environment at least 1 year, managing inbound calls, and handling high call volumes.
• To be successful in this role, you should be customer-focused, detail-oriented and efficient.
• Ability to work in a fast=paced environment and handle multiple tasks simultaneously while maintaining accuracy and attention to detail.
• Customer service skills to create a positive interaction to ensure we are building trust and longevity with our members and providers.
• Empathy and understanding to deal with sensitive health-related issues of our members
• Adherence to healthcare laws and regulations, particularly in relations to patient confidentiality and rights.
• Ability to work regularly scheduled shifts within hours of operation including the training period, where lunches and breaks are scheduled, with the flexibility to adjust daily schedule, and work over-time and/or weekends, as needed.
• This is a work from home position, which requires a quiet, private workspace without noise and distractions, and reliable internet connectivity provided through a wired connection with a minimum of 100 MBPS speed. A mobile, hot spot, or Wi-Fi connection is NOT acceptable.
• Knowledge of managed care, Commercial, Marketplace, Medicaid and/or Medicare programs; knowledge of medical policy benefits and exclusions is a plus.
• You should have excellent communication, interpersonal and negotiation skills.
• Computer Skills: Proficiency in Microsoft Office applications (Word, Excel, Outlook, PowerPoint) is essential.
• Technical Proficiency: Ability to navigate and use multiple computer applications simultaneously, including CRM systems, email platforms, and other relevant software.

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