Customer Service Representative

Job Description
You will handle inbound calls and messages from providers, members, and health plans to deliver timely, empathetic support and aim for first‑call resolution. Using Access Express and other internal tools, you’ll interpret claim information and explain findings to callers; when deeper detail is required you will navigate legacy systems (AS/400) or escalate to Claims/UM as appropriate. New hires receive three days onsite for equipment pickup and onboarding, then work remotely with ongoing shadowing and coaching.
Typical daily activities include:
• Answering inbound provider and member calls/messages via Access Express and phone
• Reviewing claim status and denial reasons; explaining CPT codes and denial rationale to callers
• Using reference guides and internal systems to determine next steps or escalation path
• Documenting call notes, actions taken, and follow‑up items in the system
• Routing or escalating complex issues to Claims, Utilization ...