Join careerzynith as a Customer Service Associate – Health Care Claims Support Specialist
Are you a service-minded professional who lights up when helping others solve complex problems? Do you enjoy the fast pace of phone-based customer interactions, the satisfaction of delivering accurate information, and the fulfillment that comes from making a real difference in people's lives? If so, careerzynith invites you to bring your talents to our growing Customer Service team as a Customer Service Associate – Health Care Claims Support Specialist.
careerzynith is a leading Third Party Administrator (TPA) serving clients across the country through our network of regional offices and a thriving remote workforce. We partner with health plans, employers, providers, and members to administer health care benefits with precision, empathy, and integrity. Our reputation is built on consistent service excellence, and our Customer Service team is the heart of that promise. Each day, our associates answer questions, resolve concerns, and provide clarity on health care claims for both providers (doctors, hospitals, clinics, and ancillary care facilities) and members navigating the often-confusing landscape of medical insurance.
As a Customer Service Associate at careerzynith, you will be the friendly, knowledgeable voice that providers and members rely on when they need prompt, accurate, and thorough answers. You will handle inbound calls, manage claim inquiries, explain benefits and coverage details, document interactions, and ensure every caller walks away with a positive, confidence-building experience. This is more than a job — it is a chance to build a meaningful career in the booming health care administration industry.
What You'll Do – Key Responsibilities
- Handle Inbound Customer Inquiries: Respond to a steady volume of incoming calls from health care providers and plan members, delivering accurate, courteous, and timely information on claim status, benefits, eligibility, and coverage details.
- Explain Health Care Claims and Benefits: Clearly communicate the nuances of medical claims processing, including deductibles, co-pays, Explanation of Benefits (EOB) statements, allowed amounts, denials, appeals, and provider reimbursement procedures.
- Navigate Multiple Systems and Tools: Use proprietary claims platforms, CRM software, and Microsoft Office applications to research, document, and resolve customer issues efficiently.
- Document Every Interaction: Maintain detailed call notes in our system of record, ensuring accurate records of inquiries, resolutions, escalations, and follow-up actions.
- Problem-Solve with Empathy: Listen actively to understand each caller's unique situation, demonstrate genuine concern, and use problem-solving skills to deliver tailored solutions that meet both customer needs and company policy.
- Adhere to Compliance Standards: Follow HIPAA regulations, internal protocols, and confidentiality guidelines when handling protected health information (PHI).
- Collaborate Across Teams: Partner with claims examiners, provider relations, and escalation teams to resolve complex issues and ensure seamless service delivery.
- Meet and Exceed Performance Goals: Achieve established metrics for call quality, average handle time, first-call resolution, customer satisfaction scores, and attendance standards.
- Continuously Learn and Grow: Stay current on benefit plan changes, regulatory updates, and process improvements through ongoing training and professional development opportunities.
What You Bring – Required Qualifications
- Education: High school diploma or equivalent (required).
- Customer Service Experience: Prior experience in a customer-facing role, preferably in a call center, health care, insurance, or benefits administration environment.
- Medical Terminology Knowledge: Solid working knowledge of medical terminology, anatomy, procedures, and the health care delivery system.
- Communication Excellence: Outstanding verbal and written communication skills, including the ability to explain complex topics in clear, simple, and friendly language.
- Technical Proficiency: Comfortable navigating Microsoft Office (Outlook, Word, Excel, Teams) and learning new software platforms quickly.
- Organizational Strength: Excellent time management, multitasking, and organizational abilities to handle a high volume of calls while maintaining accuracy and professionalism.
- Reliability: Strong attendance history and commitment to maintaining a consistent, dependable presence on the team.
- Professional Presence: Courteous, polished demeanor with a service-first mindset and a positive, team-oriented attitude.
- Language: Fluency in English (required).
Preferred Qualifications That Set You Apart
- Prior experience working in a Third Party Administrator (TPA), health insurance carrier, hospital billing department, or medical office.
- Familiarity with claims processing systems, ICD-10 codes, CPT codes, or HCPCS codes.
- Experience working in a remote or hybrid environment.
- Bilingual or multilingual capabilities are a plus.
- Previous experience using customer relationship management (CRM) tools or ticketing systems.
Essential Skills and Competencies for Success
- Active Listening: The ability to hear what callers are saying — and what they are not saying — to deliver thoughtful, personalized service.
- Empathy and Patience: Genuine compassion for callers who may be frustrated, confused, or dealing with stressful health care situations.
- Problem-Solving Mindset: A natural curiosity and analytical approach to uncovering root causes and identifying solutions.
- Resilience: The ability to stay composed and focused while handling challenging conversations or high call volumes.
- Adaptability: Comfort with change, new processes, evolving regulations, and shifting priorities in a dynamic industry.
- Attention to Detail: Precision in documentation, data entry, and benefits interpretation to avoid costly errors.
- Team Collaboration: A willingness to share knowledge, support teammates, and contribute to a positive work environment.
Why Build Your Career at careerzynith?
At careerzynith, we believe that our people are our greatest asset. That's why we invest in our associates from day one, providing the tools, training, and support needed to thrive in a rewarding career. Whether you are starting your first professional role or bringing years of experience, careerzynith offers a defined career path that allows you to grow into leadership, specialized claims roles, quality assurance, training, or management positions.
Our online training library ensures that you have continuous access to learning resources covering medical terminology, claims processes, customer service excellence, compliance, and career-advancing skills. From your first day, you will be paired with experienced mentors and leaders who are committed to your success.
Compensation, Perks, and Benefits
careerzynith is proud to offer a comprehensive benefits package designed to support your health, financial wellness, and work-life balance. Our benefits include:
- Health Insurance: Comprehensive medical, dental, and vision coverage to keep you and your family healthy.
- Life and Disability Insurance: Financial protection for you and your loved ones in the event of unexpected circumstances.
- 401(k) Retirement Plan: Plan for your future with our competitive retirement savings program.
- Generous Paid Time Off: Paid vacation, sick leave, and personal days to recharge and refresh.
- Ten Paid Holidays: Enjoy time off to celebrate the holidays that matter most to you.
- Online Training Library: 24/7 access to self-paced courses and professional development resources.
- Defined Career Path: Clear advancement opportunities with structured promotion criteria and leadership development.
- Work From Home: Enjoy the flexibility and convenience of a fully remote position, saving commute time and creating a personalized home office setup.
Work Environment and Culture at careerzynith
careerzynith is more than a workplace — it is a community. We foster a culture of respect, collaboration, inclusion, and continuous improvement. Our remote-first environment is built on trust, accountability, and open communication. You will join a diverse team of professionals who genuinely care about each other and the members and providers we serve.
We celebrate wins, recognize achievements, and provide regular feedback to help every associate feel valued and motivated. Our leaders are accessible, our teams are supportive, and our mission is clear: deliver exceptional service that makes health care easier to navigate for millions of Americans.
Position Details
- Job Type: Full-time
- Schedule: Day shift
- Work Location: Remote
- Industry: Health Care Benefits Administration / Third Party Administration (TPA)
Take the Next Step – Apply Today
If you are ready to launch or advance your career in a stable, growing industry with a company that truly values its people, careerzynith wants to hear from you. Bring your customer service skills, your passion for helping others, and your commitment to excellence — and let us show you what a rewarding career at careerzynith can look like.
Apply now and join the careerzynith team. We can't wait to welcome you aboard.
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