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Health Care Customer Service Representative Jobs

Credit Solutions LLC

Customer Service Representative

$16.50 - $22.25/hr

If you have experience in healthcare billing and finance and want a career where you can actually make a difference , apply today! Customer Service Representatives enjoy a competitive wage plus ...

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Health Care Customer Service Representative information

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How much do health care customer service representative jobs pay per hour?

As of Aug 10, 2026, the average hourly pay for health care customer service representative in the United States is $18.80, according to ZipRecruiter salary data. Most workers in this role earn between $15.38 and $20.91 per hour, depending on experience, location, and employer.

What is the difference between Health Care Customer Service Representative vs Medical Billing Specialist?

AspectHealth Care Customer Service RepresentativeMedical Billing Specialist
Required CredentialsHigh school diploma; some roles may require certification in healthcare customer serviceHigh school diploma; certification in medical billing preferred
Work EnvironmentHealthcare offices, hospitals, call centersMedical offices, billing companies, healthcare facilities
Employer & Industry UsageHospitals, clinics, insurance companiesMedical billing companies, healthcare providers
Common Search & Comparison IntentYesYes

While both roles operate within the healthcare industry, a Health Care Customer Service Representative primarily handles patient inquiries, appointment scheduling, and insurance questions. In contrast, a Medical Billing Specialist focuses on processing billing, coding, and insurance claims. Both roles require healthcare knowledge and customer interaction skills but serve different functions within healthcare operations.

What are the key skills and qualifications needed to thrive as a health care customer service representative, and why are they important?

To thrive as a Health Care Customer Service Representative, you need a solid understanding of healthcare terminology, insurance processes, and customer service principles, often supported by a high school diploma or associate degree. Familiarity with customer relationship management (CRM) systems, call center software, and medical billing platforms is typically required. Outstanding communication, patience, problem-solving abilities, and empathy help you effectively address patient and provider concerns. These skills are crucial for resolving inquiries accurately, ensuring patient satisfaction, and supporting the efficient operation of healthcare services.

What is a health care customer service representative?

Health Care Customer Service Representatives are professionals who assist patients, providers, and insurance members with questions or issues related to healthcare services and benefits. They handle inquiries about insurance coverage, medical billing, claims, appointments, and other healthcare processes. These representatives act as a bridge between patients and healthcare providers or insurers, ensuring clear communication and helping resolve any concerns quickly. Excellent communication, empathy, and problem-solving skills are essential in this role. Their work helps improve the overall patient experience and supports efficient healthcare operations.

How does a health care customer service representative typically collaborate with clinical staff and insurance providers to resolve patient issues?

Health Care Customer Service Representatives often act as a bridge between patients, clinical staff, and insurance providers. They regularly communicate with nurses, doctors, and administrative teams to clarify billing questions, schedule appointments, and ensure accurate information is relayed. Additionally, they coordinate with insurance companies to verify coverage, explain benefits, and help resolve claim issues. This collaboration requires strong communication skills, attention to detail, and a patient-centric approach to ensure smooth resolution of concerns.

How to become a health care customer service representative?

To become a health care customer service representative, candidates typically need a high school diploma or equivalent and strong communication skills. Some employers prefer experience with medical terminology or customer service, and training is often provided on the job. Proficiency with computer systems and empathy are important for success in this role.
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Health Care Customer Service Representative jobs near you

Healthcare Customer Service Representative

ssollc

Augusta, ME • Hybrid

$18/hr

Full-time

Medical, Dental, Vision, Retirement, PTO

Re-posted 10 days ago

Job description

Healthcare Customer Service Representative – Pharmacy Benefits

Location: Augusta, ME 

This position allows for 3 days of telework per week with management approval.

Pay Range: $18.00 per hour

Position Overview:

The Healthcare Customer Service Representative – Pharmacy Benefits supports MaineCare members, pharmacies, and healthcare providers by providing customer service, education, and technical assistance related to prescription coverage, Medicare Part D, and MaineCare pharmacy benefits. This role requires strong communication skills, attention to detail, and the ability to apply policies and procedures accurately.

Key Responsibilities:

Customer & Member Support

  • Respond to inbound calls from MaineCare members, pharmacists, technicians, and other stakeholders.
  • Educate members on Medicare Part D plans, Medicare Savings Programs, and MaineCare pharmacy benefits.
  • Assist members with enrollment, coverage questions, and benefit explanations.
  • Resolve issues related to copays, deductibles, premiums, medication access, and prescription fills.
  • Support members who are out of medication or unable to fill prescriptions.

Claims & Coverage Support

  • Review insurance coverage for pharmacies, providers, hospitals, and members.
  • Support claims processing activities including evaluation, pricing, and service requests.
  • Apply rules, regulations, policies, and documentation requirements to individual cases.

Administrative & Technical Support

  • Create, edit, and manage correspondence, reports, and informational materials.
  • Develop and maintain computerized forms, graphics, charts, tables, and web content.
  • Examine documents, identify errors or irregularities, and take corrective action as authorized.
  • Perform routine administrative duties including scheduling, coordinating meetings, and responding to inquiries.
  • Track and monitor contracts, licenses, fees, and reports; reconcile funds as required.

Training & Leadership (as assigned)

  • Coordinate and present training, workshops, and orientation sessions.
  • Develop standard work procedures within established guidelines.
  • Provide work direction and support to team members as needed.
  • Confer with supervisors on performance matters when applicable.

Compliance

  • Comply with all State policies, information security standards, and confidentiality requirements.
Minimum Qualifications:
  • Training, education, or experience in office or administrative support demonstrating:
    • Proficiency with modern office practices and software
    • Ability to make independent decisions within established procedures
  • Knowledge or ability to learn:
    • Medicare, MaineCare, or healthcare program operations
    • Graphics, publications, and electronic content management
    • Information distribution via the internet and web pages
  • Demonstrated ability to:
    • Prepare business correspondence and standard reports
    • Interpret and apply laws, rules, policies, and procedures
    • Detect errors, analyze information, and resolve problems
    • Present information clearly to individuals and groups
    • Exercise sound judgment and attention to detail
  • Strong customer service, communication, and organizational skills
Benefits (Through SSO)

SSO offers a competitive benefits package, including:

  • Medical, dental, and vision insurance
  • 401(k) with discretionary employer match
  • Paid time off and paid holidays
  • Flexible spending accounts (FSA)
  • Additional employee perks

Apply