Full Time map Johns Creek, (USA) Posted 60 days ago

Qualification: High school diploma or general education degree (GED)

Experience: One (1) year of experience in a customer service environment with previous insurance customer service a plus

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Job Description:

The Claims Customer Service Representative responds to a high volume of telephone inquiries from agents, service providers (doctor’s offices, hospitals, etc) and from individuals of whom we are administering healthcare coverage. Answer questions regarding health insurance coverage and document call summary. Project a professional company image through phone interaction.


  • Responds accurately to telephone, fax and/or e-mail inquiries from agents, service provider’s employers and insured’s in a professional and courteous manner while documenting information provided in the company system(s).
  • Makes outgoing calls, faxes and/or e-mails to provide information requested in a professional and courteous manner for resolution of inquiries.
  • Researches case files and consults with in-force administration and/or claims staff to determine the appropriate response to inquiries to ensure accurate information is communicated.
  • Takes accurate and detailed messages when resolution cannot be completed during the phone call so that the appropriate person/department is provided all the necessary information to research and resolve the inquiry.
  • Ability to read and interpret an insurance contract when responding to an inquiry from the caller. To be knowledgeable and keep abreast with the products, state mandates and departmental procedures after the initial training period.
  • Have a working knowledge of the systems used to answer inquiries.
  • Meet alternate work schedule requirements as needed.
  • Complete call-back’s to customers within 48 hours as required.
  • Knowledge of procedures in the claims and policy administration areas.
  • Performs similar job-related duties as assigned.


To perform this job successfully, an individual must be able to perform each essential duty satisfactorily. The requirements listed below are representative of the knowledge, skill, and/or ability required. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions.

  • High school diploma or general education degree (GED).
  • One (1) year of experience in a customer service environment with previous insurance customer service a plus.
  • Ability to make sound decisions based on deductive reasoning.
  • Excellent CSR phone skills, with experience in a high-volume call center.
  • Ability to communicate effectively on the telephone.
  • Excellent PC and data entry skills with experience in MS Word, Excel and Outlook. (Type 35 wpm).
  • Strong analytical and problem solving abilities.
  • Clear and concise oral and written communication skills.
  • Strong sense of propriety concerning confidential matters.
  • Team player, with ability to work independently and with others.
  • Multi-tasking abilities with excellent documentation and follow up skills.