Healthcare Expert

Responsibilities

• Handle inbound and outbound calls related to healthcare services, insurance benefits, claims, and eligibility verification.
• Assist members, providers, and patients with inquiries regarding coverage, billing concerns, authorizations, and account status.
• Accurately document all interactions in the system while adhering to HIPAA and company compliance standards.
• Review and verify patient/member information to ensure data accuracy and confidentiality.
• Coordinate with internal departments (claims, billing, pharmacy, prior authorization teams) to resolve concerns efficiently.
• Explain healthcare policies, procedures, and benefits clearly to customers in a professional manner.
• Escalate complex or urgent cases to the appropriate team when necessary.
• Meet or exceed key performance indicators (KPIs) such as AHT, CSAT, quality scores, and first call resolution. <...