Customer Service Representative
Location: Campbell, CA (onsite first 3 days for training) then remote after that
Schedule: Monday-Friday, 8:00 AM–5:00 PM
Duration: 6 month contract - possible extensions - possible conversion
Compensation: $24-$25/HR
Requirements:
- 2+ years customer service experience in a healthcare setting
- 1+ year experience exposed to healthcare claims related support (ability to identify claim status, denial reasons, CPT codes while utilizing related documentation for support)
- Strong phone presence and ability to multitask
- Bilingual in English and Vietnamese
Plusses:
- Prior experience with provider portals (e.g., Access Express) or claims adjudication tools
- Experience with legacy systems such as AS/400
- Background in authorizations, utilization management, or provider credentialing
Day-to-day
You will handle inbound calls and messages from providers, members, and health plans to deliver timely, empathetic support and aim for first‐call resolution. Using Access Express and other internal tools, you’ll interpret claim information and explain findings to callers; when deeper detail is required you will navigate legacy systems (AS/400) or escalate to Claims/UM as appropriate. New hires receive three days onsite for equipment pickup and onboarding, then work remotely with ongoing shadowing and coaching.
Typical daily activities include:
- Answering inbound provider and member calls/messages via Access Express and phone
- Reviewing claim status and denial reasons; explaining CPT codes and denial rationale to callers
- Using reference guides and internal systems to determine next steps or escalation path
- Documenting call notes, actions taken, and follow‐up items in the system
- Routing or escalating complex issues to Claims, Utilization Management, or Leadership
- Participating in remote coaching, quality reviews, and team huddles
- Assisting with basic authorization and inquiry triage submitted through provider portals