Representative, Support Center III in New York at Jobgether

This position is listed on behalf of a partner company, who manages all applications and next steps. Our partner is looking for a Representative, Support Center III based in the United States.

This role is an opportunity to provide high-level customer support to members and healthcare providers across multiple lines of business.
You will handle complex inquiries, investigate issues, and take ownership of cases through resolution.
The position combines phone, chat, email, and administrative support in a fast-paced, high-volume environment.
You’ll help customers navigate eligibility, benefits, claims, authorizations, appeals, contracting, and credentialing matters.
Your expertise will also contribute to improving member and provider engagement, satisfaction, and retention.
As a senior support resource, you’ll handle escalations and provide guidance and training to other representatives.
Success requires empathy, sound judgment, attention to detail, and the ability to communicate clearly while managing competing priorities.

• Provide Level III customer service through phone, chat, email, and administrative channels supporting multiple healthcare products and states.
• Research and resolve complex member and provider issues involving eligibility, benefits, claims, premiums, authorizations, appeals, contracting, credentialing, and related matters.
• Handle escalated and highly complex calls, including issues raised on behalf of leadership, while applying appropriate risk-based escalation protocols.
• Support appeals and grievances, problem research and resolution, and the development or maintenance of member and provider materials.
• Accurately document all member and provider interactions and complete required follow-up in a timely manner.
• Build rapport with customers, actively listen to their concerns, identify root causes, and provide compassionate, effective solutions.
• Support at least three lines of business, such as Medicare, Medicaid, Marketplace, or Medicare-Medicaid Plan services.
• Conduct research related to state, legislative, or regulatory inquiries and complete member satisfaction surveys when required.
• Collaborate with internal departments and support retention or inbound functions according to business needs and service-level requirements.
• Assist with training and supporting new and existing support center representatives.
• Consistently meet established performance expectations related to call quality, attendance, schedule adherence, and broader contact-center objectives.

• At least 2 years of customer service, call center, and/or sales experience in a fast-paced, high-volume environment, or an equivalent combination of education and relevant experience.
• Working knowledge of insurance products, particularly Medicaid, Medicare, and Marketplace enrollment processes.
• Strong customer service and research skills, with the ability to investigate issues while maintaining a clear and productive conversation.
• Experience with data processing and the ability to manage multiple tasks accurately and efficiently.
• Excellent verbal and written communication skills, including the ability to explain information clearly and professionally.
• Strong attention to detail, organization, time management, and follow-through.
• Ability to establish and maintain positive working relationships with members, providers, customers, coworkers, and cross-functional teams.
• Ability to protect confidential information and comply with HIPAA requirements.
• Proficiency with Microsoft Office and other relevant business software.
• Experience with platforms such as Microsoft Teams, Genesys, Salesforce, Pega, QNXT, CRM, Verint, video-conferencing tools, CVS Caremark, or Availity is advantageous.
• Previous call-center, managed-care, healthcare, or health-insurance experience is preferred.
• A broker or health-insurance license is a plus.

• Full-time, fully remote position within the United States.
• Competitive hourly compensation of approximately $13.41–$29.06, depending on geographic location, experience, education, and skill level.
• Opportunity to support members and healthcare providers across multiple products and states.
• Exposure to complex healthcare-service, insurance, regulatory, and customer-engagement matters.
• Opportunities to develop expertise across Medicare, Medicaid, Marketplace, and related lines of business.
• Opportunity to contribute to customer-experience improvements and support the development of other representatives.
• Competitive benefits and compensation package.
• Equal-opportunity workplace with reasonable accommodations available to qualified applicants.