[Remote] Healthcare Customer Service Representative – Claims & Member Services

Note: The job is a remote job and is open to candidates in USA. KMM Technologies, Inc. is seeking a member service representative to handle healthcare member inquiries and support claims, enrollment, and billing transactions. The role provides accurate information about benefits and policies, resolves service issues, and documents customer interactions.

Responsibilities

• Respond to inbound member inquiries regarding benefits, claims, enrollment, billing, and policy information
• Research and resolve customer service issues, escalating complex cases when necessary
• Review claims, verify processing requirements, and assist with resolving payment discrepancies
• Support enrollment transactions and billing activities in accordance with established guidelines
• Educate members, clients, providers, and group administrators on benefits, contractual provisions, and procedures
• Maintain accurate documentation of customer interactions and follow established service standards
• Navigate multiple systems simultaneously while delivering excellent customer service
• Collaborate with internal teams and clinical professionals to support appropriate managed care interventions

Skills

• High school diploma or GED
• Minimum of 1 year of customer service, claims processing, or inbound call center experience
• Experience in healthcare, health insurance, medical information, or claims-related operations
• Strong verbal and written communication skills
• Excellent problem-solving, organizational, and time-management abilities
• Ability to work independently in a remote, fast-paced, quality-driven environment
• Proficiency in Microsoft Office, email, internet research, and navigating multiple software applications
• Preferably 2–5 years of inbound call center experience

Benefits

• 100% Remote (DMV + 11 regions)

Company Overview