Costumer Care Representative

Position Summary

The Customer Service Member Support Rep serves as the frontline member advocate and primary point of contact for Detego Health members. This role assists members with routine questions regarding eligibility, benefits, claims, billing, provider networks, pharmacy benefits, and available member resources while delivering a professional, empathetic, and member-focused experience.

Customer Service Member Support Rep team members work within established procedures, workflows, and service standards to resolve routine inquiries, educate members regarding their coverage, accurately document interactions, and escalate complex or unresolved concerns as appropriate.

This is a non-clinical customer service position focused exclusively on health insurance navigation and member advocacy. Customer Service Member Support Reps do not provide medical advice, diagnose medical conditions, recommend treatments, interpret clinical information, or deliver healthcare services.

• Deliver a positive, professional, empathetic, and member-focused experience during every interaction.
• Verify member identity and protect confidential information in accordance with HIPAA and company privacy requirements.
• Educate members regarding eligibility, enrollment, benefits, claims, billing, provider networks, pharmacy benefits, prior authorizations, reimbursement programs, and available member resources.
• Research and resolve routine member inquiries using approved systems, knowledge bases, and internal resources.
• Accurately document all member interactions in Salesforce CRM and other required systems.
• Conduct outbound calls for follow-up, education, issue resolution, and member engagement as assigned.
• Escalate complex, sensitive, or unresolved issues to appropriate internal resources or higher-level Care Guides.
• Meet departmental standards for quality, productivity, average handle time, first call resolution, documentation accuracy, schedule adherence, attendance, and compliance.
• Participate in training, coaching, team meetings, and continuous improvement activities.
• Perform other related duties as assigned.

Qualifications

Excellent customer service, communication, active listening, conflict resolution, and de-escalation skills.

• Ability to build rapport and provide an exceptional member experience.
• Ability to work in a fast-paced, metrics-driven call center environment.
• Ability to handle consecutive inbound and outbound calls while balancing efficiency, quality, and accuracy.
• Strong computer navigation skills and ability to work across multiple applications and monitors simultaneously.
• Strong documentation, data entry, and CRM/case management system skills.
• Ability to learn new software systems and internal processes quickly.
• Understanding of eligibility, enrollment, benefits, claims, provider networks, pharmacy benefits, deductibles, copayments, coinsurance, out-of-pocket maximums, prior authorization, and Explanation of Benefits.
• Ability to educate members about benefits without providing medical advice.
• Strong analytical and problem-solving skills.
• Sound judgment when handling confidential, sensitive, or escalated member information.
  

Equal Opportunity Statement

Detego Health is an Equal Opportunity Employer. We are committed to an inclusive workplace.

Benefits & Compensation
Pay: 21.00 – 24.00

Work Location: In Person
Benefits:

401(k) matchingnce

• Employee assistance program

• Health insurance

• Paid time off

• Vision insurance