Job Description

Aspire Health Plan

Coastal TPA

Full Time

Day shift

M - F 8AM - 5PM



Customer Service Representative

Position Highlights

  • Excellent Pay and Generous Benefits including Medical, Dental, Vision, 401k and PTO
  • Continuing Education Allowance
  • Team Oriented Culture

Position Summary

The Customer Service Representative is responsible for answering telephone inquiries and responding to correspondence from employer clients, members and providers regarding eligibility, claims status and benefit determinations.


  • Intake all customer (provider, member and health plan) calls as they relate to inquiries and grievances.
  • Explain health insurance benefits, policies and procedures to members and providers, i.e., claims submission, appeal process, medical review, documenting all communication.
  • Investigate timely filing of provider claims.
  • Serve as a point of contact and liaison for customers.
  • Successfully implement dispute resolution.
  • Provide proactive and event-related education to customers.
  • Facilitate customer care as appropriate.
  • Assure accurate and timely response to all customer inquiries.
  • Log calls and document action plans.
  • Successfully bring all issues to closure within appropriate timeframe.
  • Proactively identify areas of improvement and provide feedback.
  • Perform member and provider satisfaction surveys as appropriate.
  • Provide support and coverage to interdepartmental staff as needed.
  • Coordinate customer grievances with appropriate department.
  • Develop strong partner relationship with customers.
  • Perform other activities and functions as defined by the Claims Manager.

Experience/Skill Set required:

  • Minimum two years' experience in customer service/call center within the managed care, insurance, healthcare, or related call center environment
  • Strong comprehension skills
  • Ability to communicate effectively, including written and verbal communication skills
  • Attention to details in obtaining complete and accurate information
  • Problem resolution skills
  • Strong interpersonal and negotiation skills
  • Ability to key data accurately and rapidly
  • Basic knowledge of insurance terminology and medical coding, e.g. ICD and CPT
  • Ability to operate computer equipment and software programs necessary to fulfill position responsibilities
  • Working knowledge of Microsoft office products including Outlook, Word, and Excel
  • Ability to interact professionally with co-workers, providers, clients, brokers and management-level staff
  • Excellent phone manner and ability to handle multiple phone lines
  • Must be able to meet established deadlines


· Minimum A.A. degree or equivalent practical experience in related or similar positions.

About Aspire

Aspire Health Plan is a locally owned Medicare Advantage HMO that provides comprehensive medical coverage to seniors and other Medicare recipients in Monterey County. We're proud to be a community-centered organization backed by Community Hospital of the Monterey Peninsula and Salinas Valley Memorial Hospital. Over 700 doctors, many other healthcare providers, and all four Monterey County hospitals are part of the Aspire Health Plan network. It's the care you need from people you know.

Equal Opportunity Employer

Application Instructions

Please click on the link below to apply for this position. A new window will open and direct you to apply at our corporate careers page. We look forward to hearing from you!

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