Customer Service Representative - Healthcare Insurance Support

Company Overview

Resonance CX Partners aims to connect experienced professionals with roles aligned to their personal and professional values. We do not hire directly but collaborate with customer-focused companies to identify validated openings. Wellfleet, a Berkshire Hathaway company, specializes in customer-oriented accident and health insurance services designed to protect individuals throughout all life stages, from school to workplace. Established in 1993 as Consolidated Health Plans, Wellfleet is headquartered in Springfield, Massachusetts, and is a major provider of health and accident insurance products for the higher education market.

Role Summary

We are seeking seasoned Health Insurance Customer Service Representatives to join the Wellfleet Student Health team. This position requires working from 8:30 AM to 5:00 PM Pacific Standard Time (11:30 AM to 8:00 PM Eastern Standard Time). The role focuses on managing the operational tasks linked to customer service for health insurance offerings administered by Wellfleet. Key responsibilities include ensuring adherence to company policies, maintaining high-quality service delivery, complying with industry best practices, responding to customer inquiries, and staying informed about relevant state and federal regulations.

Key Responsibilities

• Complete all training successfully and begin handling calls within the Customer Service department.
• Utilize customer service skills effectively when managing member and provider calls in the call center environment.
• Handle calls by listening attentively, communicating clearly and professionally, and using efficient call management strategies to fulfill commitments.
• Respond promptly to calls, fully understand caller needs via clarifying questions, demonstrate empathy, provide accurate answers, and either resolve issues or escalate appropriately.
• Acquire foundational knowledge about insurance and maintain an up-to-date understanding of Wellfleet health insurance products.
• Navigating departmental systems proficiently and efficiently.
• Achieve and sustain quality performance and schedule adherence as defined by leadership.
• Interpret and comprehend various documents such as training materials, correspondence, and brochures.
• Manage multiple tasks throughout the day to meet department goals and expectations.
• Maintain a consistently positive and professional demeanor.
• Adhere to all deadlines and turnaround times.
• Stay engaged and motivated, both as an individual and team member.
• Ensure all equipment used for job functions operates optimally, report issues promptly to supervisors, and submit IT tickets when necessary.
• Perform additional duties as assigned.

Candidate Requirements

• At least one year of experience in customer service within a health insurance environment or medical billing office, with familiarity in medical terminology and benefit plan structures.
• Proven call center experience with strong customer service abilities.
• Comfort and experience working with digital platforms supporting calls, chats, and email communication.
• Excellent verbal, written, and interpersonal communication skills.
• Professional phone etiquette and the ability to engage positively with callers.
• Strong attention to detail paired with effective time management.
• Good problem-solving and decision-making capabilities.
• Genuine enthusiasm for assisting others with empathy.
• Commitment to resolving customer inquiries promptly and efficiently at first contact.
• Strong work ethic, accountability, and reliability towards team and members.
• Dependability reflected in punctuality and attendance discipline.
• Proficiency with Microsoft Office Suite and Windows applications; ability to learn and navigate complex systems.
• Capacity to multitask without compromising service quality.
• Willingness to participate in trainings and meetings with video functionality.
• Flexibility to adapt to a dynamic workplace including accommodating overtime and varying schedules as needed.
• Ability to work the specified core hours of 8:30 AM to 5:00 PM PST (11:30 AM to 8:00 PM EST).
• Maintain a private, distraction-free, dedicated workspace for remote job functions.

Additional Information

This position is based in the United States and requires physical attendance onsite. The role does not specify salary details. The employer fosters a culture of growth, empowering employees to deliver exceptional service and achieve professional success through engagement and high performance.