Customer Service Representative I

MagnaCare is seeking detail-oriented and empathetic Las Vegas-based Customer Service Representatives to join our team. In this role, you will provide telephonic support to members, physicians, hospitals, revenue agencies and other healthcare providers with member benefits, eligibility, claims inquiry, claim reconsiderations and appeals.  Key Responsibilities: Handles frontline Culinary, Hospitality and/or Alaska volumes,  Provide timely and professional support to members and providers regarding benefits, eligibility, claims, and appeals. 
Will be required to handle customer service inquiries via the contact center phones, email, and chat depending on business needs.
 
Key Responsibilities:

• Handle escalated customer concerns and complaints 
• Assist with Claims processing.  
• Collaborate with the Benefits Enrollment team to resolve eligibility, hours, and co-premium inquiries, proactively following up with members as needed. 
• Actively listen to customer concerns, demonstrating empathy and offering effective solutions. 
• Analyze and resolve non-standard and complex issues using critical thinking and problem-solving skills. 
• Maintain a strong understanding of client products, services, and policies to provide accurate and informed assistance. 
• Document all interactions and resolutions accurately in the system to ensure seamless customer service. 
• Adhere to regulatory requirements, company policies, and confidentiality guidelines when handling member information.

Qualifications: 

• Prior customer service experience serving unions preferred. 
• Prior customer service experience in a high-volume call center, preferably in healthcare, insurance, or a related field is required.   
• Experience with claims inquiry and claims review procedures, knowledge of medical specialties, fee schedules, complaints and appeals and call center responsibilities required.
• Strong communication skills with the ability to explain complex information in a clear and empathetic manner. 
• Ability to manage multiple inquiries while maintaining attention to detail and accuracy. 
• Problem-solving skills and the ability to navigate complex eligibility and claims issues. 
• Effective communication through various channels, including email, chat, and voice 
• Salesforce experience preferred. 
• Bilingual preferred 
• Intermediate proficiency in Microsoft Office (Word, Excel, Outlook).