Call Center Agent at Anchor HMO

Key Skills Required:

• Strong communication and listening skills
• Patience and empathy
• Problem-solving ability
• Multitasking and time management
• Basic computer/CRM proficiency

Job Role

• Attend to incoming calls from enrollees, providers, and prospects; make outbound calls when necessary.
• Provide accurate information on HMO plans, benefits, hospital access, and service processes.
• Handle and resolve complaints related to authorization, claims, access to care, or service delays.
• Liaise with hospitals and healthcare providers to confirm enrollee eligibility, approvals, and services.
• Confirm enrollee identity, plan type, and eligibility before providing services or information.
• Assist with pre-authorization requests and guide providers/enrollees on approval processes.
• Help enrollees with issues related to e-cards, login access, and mobile app usage.
• Escalate complex or unresolved issues to the appropriate department (Claims, IT, Provider Management).
• Maintain professionalism, confidentiality, and adherence to company policies and healthcare regulations.