Job Description

Account Advisor I (Customer Service Representative)
Location: Baton Rouge, LA (Remote)
Pay Rate: $18.50/hr

Position Summary

The Account Advisor I serves as the first point of contact for members, providers, and other stakeholders by resolving inquiries related to benefits, claims, eligibility, billing, and other healthcare insurance matters. This role operates in a high-volume call center environment and is responsible for delivering exceptional customer service while ensuring accuracy, compliance, and timely resolution of issues.

The ideal candidate is customer-focused, detail-oriented, and able to effectively communicate complex information in a clear and professional manner. Success in this role requires strong problem-solving skills, the ability to navigate multiple systems simultaneously, and a commitment to achieving performance and quality standards.

Key Responsibilities

• Respond to inbound member and provider inquiries via telephone and approved communication channels.
• Assist customers with questions regarding benefits, claims, eligibility, billing, payments, adjustments, refunds, and related healthcare insurance services.
• Research and resolve issues by utilizing multiple internal systems and collaborating with cross-functional departments.
• Explain healthcare benefits, policies, procedures, and claim outcomes in a clear and understandable manner.
• Accurately document customer interactions, resolutions, and follow-up actions.
• Maintain current knowledge of healthcare products, benefits, policies, procedures, and regulatory requirements.
• Demonstrate ownership of customer concerns and work toward First Call Resolution (FCR) whenever possible.
• Meet established performance metrics related to quality, productivity, customer satisfaction, attendance, and call handling.
• Escalate complex issues appropriately while ensuring a positive customer experience.
• Maintain confidentiality and comply with all applicable HIPAA, regulatory, and company requirements.
• Participate in required training programs and ongoing professional development.
• Perform additional duties as assigned.

Required Qualifications

Education

• High School Diploma or GED required.

Experience

• Minimum of one (1) year of customer service experience or medical office experience required.
• Equivalent completion of a Medical Assistant, Coding, or Insurance training pathway may be considered in lieu of experience.

Preferred Qualifications

• Previous call center experience.
• Healthcare, health insurance, or managed care experience.
• Experience working with claims, eligibility, benefits, billing, or provider services.
• Familiarity with healthcare and insurance terminology.

Knowledge, Skills & Abilities

• Excellent verbal and written communication skills.
• Strong customer service orientation with the ability to demonstrate empathy and professionalism.
• Critical thinking and problem-solving abilities.
• Ability to multitask and manage multiple systems in a fast-paced environment.
• Strong attention to detail and organizational skills.
• Effective conflict resolution and de-escalation skills.
• Active listening and effective questioning techniques.
• Ability to learn and apply complex healthcare policies and procedures.
• Proficiency with Microsoft Office applications and computer-based systems.
• Ability to maintain confidentiality and handle sensitive information appropriately.

Work Environment

• High-volume customer service call center environment.
• Approximately 95% of work time spent handling inbound customer calls.
• Frequent use of computer systems and multiple applications simultaneously.
• Position may require work during emergency operations or inclement weather events.
• Successful completion of customer service training and demonstrated proficiency required.