Healthcare Customer Service Representative (Richmond, VA)

Position: Healthcare Customer Service Representative Type: 6-Month Contract-to-Hire Location: REMOTE - Must Site in Either the Hampton Roads or Richmond, VA Area Hours: 8am-6pm EST Pay Range: 17-20/HR Overview: We are seeking a dedicated Healthcare Customer Service Representative to join our team. This role involves assisting members with inquiries related to their insurance plans, eligibility, benefits, and claims. The ideal candidate will have a strong understanding of various insurance plan types and excellent communication skills. Key Responsibilities: Healthcare Basics Recognize and understand various insurance plan types, including Commercial, Individual Products, HIX, and Government Plans (Medicaid/Medicare). Familiarity with common insurance terminology and procedures. Phone Skills Receive and respond to member inquiries via inbound calls using NICE inContact - Max Agent. Make outbound calls to members, vendors, and other departments. Follow established call flow processes for member interactions. Understand and apply protocols for using the language line for effective communication. Eligibility and Enrollment Verify member status, including ID numbers and personal information, using Salesforce, CSC, and QNXT. Confirm member eligibility and plan effective dates. Manage member correspondence, including sending plan documents and updating demographics. Provider Information Verify provider status (NPI, Tax ID) and understand provider types and specialties. Assess whether providers are Par or Non-Par and recognize specialty networks. Website Assistance Educate members on using the Sentara/OHP website and assist in creating member accounts. Help members locate necessary forms and documents. Benefits Administration Locate, interpret, and quote benefit information, including covered/excluded benefits and member out-of-pocket costs. Familiarity with various plan documents and protocols for coordination of benefits. Authorizations Understand diagnosis codes (ICD 9-10) and procedure codes (CPT and HCPCS). Provide updates on authorization status and address member inquiries regarding pending or denied authorizations. Claims Management Recognize and understand different claim types and statuses. Review claims details with members and assist with EOB inquiries. Grievance and Appeals Initiate grievance and appeals requests over the phone and communicate with the G&A department as needed. Collaboration Work closely with the Quality Team, L&D Team, and other departments to ensure high-quality service delivery.