Position Overview:
We are seeking a Customer Services Specialist with proven experience in the healthcare industry to support a range of health plan product lines. This role requires direct experience resolving inquiries related to medical coverage and services. The ideal candidate will deliver prompt, courteous, and accurate support to members, investigate and resolve service issues, and contribute to improving the overall customer experience.
Key Responsibilities:
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Respond to member inquiries by phone, mail, and in person, ensuring thorough documentation and timely follow-up.
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Educate members and prospects on healthcare plan offerings, policies, procedures, and benefits.
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Maintain compliance with privacy and HIPAA guidelines.
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Monitor inquiry cases and take proactive steps to ensure resolution and service satisfaction.
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Collaborate effectively with internal departments and provider offices to gather information and resolve member concerns.
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Analyze inquiry trends and recommend improvements to enhance service quality and efficiency.
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Participate in training sessions, special projects, and member outreach efforts as needed.
Required Qualifications:
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Minimum two years of recent customer service experience specifically in a medical or healthcare call center environment.
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Demonstrated understanding of health plan structures including HMO, PPO, and POS models.
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Strong interpersonal, verbal communication, and business writing skills.
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Proven ability to manage multiple priorities and resolve complex service issues.
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Proficiency with Microsoft Office and familiarity with member service tracking systems.
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Commitment to service excellence, professionalism, and patient confidentiality.
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Flexibility to work evenings and weekends as needed.
Education Requirements:
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Associate's Degree or a minimum of four years of recent, relevant healthcare customer service experience.
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Completion of a medical terminology course within six months of hire is required.
If you are a high performer and would like to work for an equally high performing company and you think the above opportunity is appropriate for you, we invite you to apply to this job and email your resume to
We treat all resumes with strict confidentiality. We will always contact you first before submitting your resume to our client(s) for review. If you do not receive correspondence, you are not a fit for this position.
At Harvard Resource Solutions, our talent acquisition team is proud to provide our clients with the most qualified Administrative & Clerical talent in the industry today.