[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 customer-focused representative to support healthcare members with claims, enrollment, billing, and benefits inquiries. The role involves resolving service issues, documenting interactions, educating members and providers, and coordinating with internal teams and clinical professionals.

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