Customer Service Specialist

Medical Customer Service Specialist – Voice

Job Summary

As a Medical Customer Service Specialist, you will be responsible for assisting members and customers with inquiries related to healthcare services, insurance coverage, benefits, claims, providers, and medical-related processes. You will provide professional and empathetic support while ensuring accurate information, data confidentiality, and compliance with applicable healthcare and client policies.

This role requires strong communication skills, attention to detail, problem-solving abilities, and the ability to handle sensitive customer information in a fast-paced customer service environment.

Key Responsibilities

• Handle inbound customer calls and provide accurate and professional support regarding healthcare services, insurance benefits, claims, coverage, and provider networks.
• Assist customers with inquiries related to eligibility, benefits, referrals, pre-authorizations, and claims status.
• Resolve customer issues related to billing, payments, coverage, and healthcare services.
• Protect and handle sensitive customer and medical information in accordance with HIPAA requirements and applicable data privacy policies.
• Demonstrate empathy and professionalism when handling sensitive or complex medical-related customer concerns.
• Collaborate with internal teams and relevant departments to resolve complex customer inquiries and ensure timely resolution.
• Document customer interactions, inquiries, and resolutions accurately in CRM and other relevant systems.
• Meet and maintain key performance metrics, including Customer Satisfaction (CSAT), Quality, Average Handling Time (AHT), First Call Resolution (FCR), and Attendance.
• Maintain a strong understanding of healthcare processes, client policies, procedures, and service updates.
• Adapt to changes in healthcare policies, procedures, and client requirements.
• Maintain professionalism and confidentiality at all times when dealing with sensitive customer information.

Job Qualifications

Education:

• Minimum: High School Diploma or equivalent.
• Bachelor's degree in any discipline is preferred.

Experience:

• Minimum 1 year of customer service experience, preferably within a call center/BPO environment.
• Previous experience in healthcare, medical insurance, health insurance, or a related field is highly preferred.

Required Skills

• C1 English verbal and written communication skills.
• Strong listening and interpersonal skills.
• Excellent customer service and problem-solving abilities.
• Ability to communicate complex information in a clear and simple manner.
• Strong attention to detail and accuracy.
• Ability to remain calm, professional, and empathetic when handling difficult or sensitive situations.
• Ability to handle high-volume inbound calls while maintaining service quality.
• Good computer skills and ability to navigate multiple systems simultaneously.
• Familiarity with CRM and customer support platforms is preferred.
• Strong ability to follow procedures, policies, and compliance requirements.
• Ability to work effectively in a fast-paced BPO environment.
• Flexibility to work rotational shifts, weekends, and public holidays when required.

Preferred Healthcare Knowledge

Candidates with knowledge or experience in any of the following areas will be highly preferred:

• Medical Insurance
• Health Insurance
• Healthcare Benefits
• Claims Processing
• Provider Networks
• Referrals
• Pre-Authorization
• Eligibility & Coverage
• Medical Terminology
• Healthcare Customer Service

1+ year Customer Service/BPO experience + B2/C1 English + strong communication/problem-solving skills

What We Offer:

• Competitive Salary Package
• Private Medical Insurance
• Social Insurance
• Paid Annual Leave & Public Holidays
• Transportation Support
• Performance-Based Incentives
• Paid Training & Development
• Career Growth Opportunities
• Employee Recognition Programs
• Opportunity to be part of a newly launched medical BPO operation in Egypt