Job Summary

Serve as a customer service specialist for healthcare payer clients resolving complex member and provider inquiries with accuracy and empathy while working hybrid night shifts. Apply strong MS Office skills and solid understanding of HIPAA guidelines to protect sensitive data enhance service quality and support efficient claim and benefit issue resolution in a highly regulated environment.

Responsibilities

Handle inbound and outbound customer interactions for payer related queries with clear communication and timely resolution while maintaining high service quality in a hybrid night shift environment.
Document customer contacts case details and resolutions using MS Office tools to maintain accurate records that support audit readiness and continuous service improvement.
Use spreadsheets and word processing applications to track trends in issues such as claims benefits eligibility and billing so that recurring problems can be identified and reported for process enhancement.
Apply detailed working knowledge of HIPAA rules in every interaction to safeguard protected health information and reduce the risk of privacy violations and regulatory non compliance.
Coordinate with internal payer operations teams to research complex claim or policy questions and provide customers with clear explanations that improve understanding and reduce repeat contacts.
Analyze customer complaints and feedback to pinpoint root causes and propose practical changes that improve first contact resolution and overall service experience for members and providers.
Follow standard operating procedures and quality checklists for payer processes so that each interaction aligns with contractual service levels and regulatory obligations.
Use call handling and ticketing systems alongside MS Office to prioritize work queues manage follow ups and ensure that all cases are closed within agreed timelines.
Collaborate with quality and training teams by sharing real world call scenarios and documentation gaps that can be used to refine scripts reference materials and learning content.
Support night shift operations by being flexible with schedules adhering to attendance expectations and contributing to a stable coverage model for critical payer support windows.
Communicate clearly with peers and supervisors during hybrid work through regular virtual check ins and status updates so that team members remain aligned on workload and performance goals.
Maintain up to date understanding of payer products plan changes and policy updates by reviewing reference documents and participating in refresh sessions that improve customer guidance.
Contribute to company purpose by resolving healthcare access and coverage issues in a way that reduces stress for customers and supports better health outcomes in the communities served.

Qualifications

Demonstrate practical experience using MS Office applications to document interactions create simple reports and manage case related data for at least one year in a customer facing role.
Show strong understanding of HIPAA requirements through prior work with protected health information and consistent application of privacy and security practices in daily tasks.
Bring hands on exposure to payer processes such as claims authorizations benefits or member services and use that knowledge to explain complex topics in simple terms.
Display effective written and verbal communication skills that support empathetic conversations with diverse customer groups during demanding night shift schedules.
Exhibit ability to work independently in a hybrid model by managing time internet connectivity and focus while still collaborating actively with remote and onsite team members.
Apply basic analytical thinking to review customer data identify discrepancies and escalate issues with clear documentation that helps back office teams resolve cases quickly.

SPE-Customer Service HC