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Customer Service Representative II


Centivo is a new type of health plan administrator that allows self-funded employers and clinicians to join forces and deliver high quality, affordable healthcare to their employees. An alternative to traditional insurance carriers or third-party administrators, Centivo offers the technology, network, claims processing, customer support, and population health management to fully administer health benefits for all or a portion of an employee population.


At Centivo, we never lose sight of the fact that we are dealing with healthcare, with emotions, with anxiety, with fear, and with lives. We treat your employees and their families with the same level of care that we would use to treat our own families.

Summary of this role:

The Customer Service Representative II (CSRII) will provide high level customer service support to members and providers regarding benefits, eligibility and claims reimbursement via inbound calls, outbound calls, email, and fax. The CSRII will also be the 1st Level of Escalation and will respond to customer inquiries/complaints and ensure that appropriate action is taken.

In this position you will have the following responsibilities:

  • Accept inbound calls from members and providers on inquiries pertaining to benefits, eligibility, and claims
  • Research complex inquiries by use of tools, documentation, and outbound calls
  • Educate members and providers on benefits and navigation of Centivo site, tools, and applications
  • Document all interactions and ensure proper processes/procedures are followed and follow up action is taken
  • De-escalate calls when necessary
  • Address first level complaints and provide assistance on appeals as needed; receive and effectively resolve written inquiries from members/providers regarding claims, benefits, eligibility, reimbursement and participating providers
  • Minimum of 1 year of experience meeting expectations in a CSRI role
  • 1st Level of Escalation – Respond to customer inquiries/complaints and ensure that appropriate action is taken, and accurate/detailed notes are placed in the proper systems
  • Complete special projects as needed
  • Respond to complex issues, interactions, and sensitive cases, as appropriate
  • Make process improvement recommendations
  • Has expertise on assigned clients and/or processes


  • Minimum of one (1) year of experience meeting expectations in a CSRI role
  • Experience in the health and/or insurance industry
  • Proficiency in Microsoft Office applications and other web-based software applications
  • Ability to learn new proprietary computer systems
  • Demonstrated ability to communicate professionally, both written and verbal
  • Detail oriented
  • Successful completion of mandatory in classroom 4-week training on Self-funded products (medical, dental and vision), Pharmacy Benefit Dimensions (PBM) and Health Reimbursement
  • Ability to handle basic to moderate level member inquiries and basic computer knowledge
  • Adhere to all legal regulations by handling confidential information with sensitivity and discretion in accordance with HIPAA and Data Privacy laws

Education and Experience:

  • High School Diploma or GED required
  • 1-2 years of previous experience providing customer support in a healthcare/insurance/TPA setting

Preferred Qualifications:

  • Associates Degree or Bachelor’s Degree
  • Claims experience and/or medical billing experience
  • Experience with CPT codes, ICD-9/ICD-10 coding, and medical terminology
  • Fast-paced Call Center experience
  • Bilingual

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