Customer Service representative-Medicaid

Position : Medicaid CSR

Location: 100% Remote

Domain:  Healthcare insurance domain

Duration: Fulltime Permanent role

Responsibilities:

• Respond to inbound calls and emails from Medicaid members and providers regarding benefits, coverage, and claims.
• Explain Medicaid plan features, policies, and procedures clearly and accurately.
• Assist members with eligibility checks, enrollment, renewals, and ID card requests.
• Research and resolve claim issues, billing concerns, and service requests.
• Document all interactions accurately in client systems and maintain data confidentiality.
• Coordinate with claims, provider relations, and case management teams for issue resolution.
• Ensure compliance with HIPAA guidelines and Medicaid regulatory requirements.
• Meet service-level agreements (SLAs) and performance metrics.

Required Qualifications

• High school diploma or bachelor’s degree in healthcare administration, business, or related field preferred.
• 2+ years of experience in healthcare customer service, insurance support, or call center environment.
• Basic knowledge of Medicaid programs and managed care plans.
• Strong communication, listening, and problem-solving skills.
• Ability to handle high call volumes and work in a fast-paced environment.
• Proficiency with CRM tools, claims systems, and MS Office.