Job Description
A third-party health insurance administrator is hiring a Customer Service Representative to support growing member and provider volume. This is a high-volume, structured call center role operating Monday–Friday, 9:00 AM–5:00 PM (no flex scheduling).
This position is critical to daily operations, handling inbound calls related to eligibility, benefits, claims status, pre-authorizations, and provider inquiries. Representatives are cross-trained across multiple functions and are expected to take ownership of calls, resolve issues end-to-end, and deliver a strong member/provider experience.
This is a fast-paced role best suited for individuals who are reliable, self-sufficient, and comfortable handling complex or escalated conversations with professionalism and patience.
Key Responsibilities:
Handle 30–50 inbound calls per day from members and providers
Assist with eligibility, benefits, claims status, pre-certifications, and general inquiries
Investigate claims, identify issues, and coordinate with internal claims teams or external providers/vendors to resolve
Navigate plan documents (SPDs) and systems to accurately explain coverage, limitations, and member responsibility
Document all interactions thoroughly in the system
De-escalate frustrated callers and provide clear, professional communication
Work across multiple systems and adapt to new platforms and processes
We are a company committed to creating diverse and inclusive environments where people can bring their full, authentic selves to work every day. We are an equal opportunity/affirmative action employer that believes everyone matters. Qualified candidates will receive consideration for employment regardless of their race, color, ethnicity, religion, sex (including pregnancy), sexual orientation, gender identity and expression, marital status, national origin, ancestry, genetic factors, age, disability, protected veteran status, military or uniformed service member status, or any other status or characteristic protected by applicable laws, regulations, and ordinances. If you need assistance and/or a reasonable accommodation due to a disability during the application or recruiting process, please send a request to HR@insightglobal.com.To learn more about how we collect, keep, and process your private information, please review Insight Global's Workforce Privacy Policy: https://insightglobal.com/workforce-privacy-policy/.
Required Skills & Experience
Medical call center or health insurance experience required (claims, benefits, eligibility, or member services)
Knowledge of CPT or ICD-10 codes
Strong understanding of medical insurance concepts (deductibles, coverage, pre-certifications, claims processing)
Experience handling high-volume inbound calls with professionalism and empathy
Excellent verbal communication skills and strong phone presence
Ability to work independently with minimal supervision and ramp up quickly
Nice to Have Skills & Experience
Experience working with PPO networks or provider relations
Familiarity with vendors such as Anthem or specialty pharmacy providers
Bilingual (Spanish)
Experience with CRM or call-tracking systems
Benefit packages for this role will start on the 1st day of employment and include medical, dental, and vision insurance, as well as HSA, FSA, and DCFSA account options, and 401k retirement account access with employer matching. Employees in this role are also entitled to paid sick leave and/or other paid time off as provided by applicable law.