Medical Insurance Call Center Representative

Medical Insurance Call Center Representative [Full Time]

Clearwater, FL

Premier Administrative Solutions (PAS) is a Third-Party Administrator that provides a wide range of administrative services to insurance companies, sharing organizations, insurance marketing organizations, and employers. One such service is Member and Provider Services, where inbound and outbound calls and correspondence from members or covered individuals and their providers are managed. This role is critical to PAS’ success, effectively and efficiently handling calls and correspondence while meeting strict service level agreements for accuracy, resolution, and satisfaction.

• VERY competitive pay/compensation package
• Monthly metric-based bonuses!
• NO selling, NO weekends
• Monday - Friday, Day Shift
• Paid Training, Health, Dental, Vision, and Life Insurance as well as Paid Time Off and Paid Holidays
• Health Coverage – two flexible medical plans
• Dental & Vision – comprehensive coverage by Sun Life;
  Vision is company paid
• Health Savings Account (HSA) – pre‑tax contributions
• Flexible Spending Accounts (FSA) – Medical and Dependent Care options
• Life & Disability Insurance – company‑paid with optional additional coverage
• Generous Paid Time Off (PTO) and additional paid holidays
• Employee Assistance Program (EAP) – wellness support
• 401(k) Retirement Plan – company match after meeting eligibility requirements
• Frequent and ongoing employee appreciation and celebration throughout the company

• Participate in team meetings and discussions to improve service results
• Promote a culture of exceptional service and transparency with team supervisors and management
• Meet department productivity standards (calls per day/week, queue time, service levels such as 45‑second answer, average speed to answer, longest hold time, and abandon rate)
• Maintain a pleasant and helpful demeanor on the telephone, ensuring members’ and providers’ needs are met
• Accurately identify caller issues and provide clear, understandable responses (minimum 3 calls per week audited for accuracy)
• Document all calls per company standards (caller, reason for the call, sufficient information for team members)
• Escalate calls appropriately via transfer to a senior representative or supervisor
• Explain steps and expected time frames for research‑intensive calls, and maintain responsibility for status communication
• Adhere to HIPAA Privacy and Data and System Security policies at all times

• Ensure messages left for the team or outbound calls are followed up within 1 working day
• Respond to correspondence received by the team within 1 working day; urgent e‑mail within 4 hours
• Follow attendance policies (planned time off, sickness, start time, break times)
• Identify and share ideas for improving documentation or approach with the supervisor

• 80% of calls reach a live representative within 30 seconds
• Average speed to answer less than 30 seconds
• Abandon rate less than 5%

• Handle a minimum of 275 transactions per week (calls, outbound calls where the target is reached, written responses)

• Minimum of 10 calls per week audited with an overall team score of at least 95%

• High school graduate or equivalent
• Knowledge of medical terminology, billing, claims, and the health insurance industry is strongly preferred but not required
• At least one year experience in an inbound customer service center focused on health insurance or provider billing
• Strong organizational, interpersonal, and motivational skills
• Excellent listening, written, and verbal communication skills
• Ability to perform multiple tasks simultaneously (listening, navigation, documentation)

Work is performed in an office environment. Employees are required to maintain active communication with customers, access and input data into computer systems, and use a keyboard and monitor for extended periods. Repetitive motion such as typing and data entry, and occasional light lifting up to 30 pounds may occur.

• Abso…