What Does a Healthcare Customer Care Representative Do?
In healthcare organizations, customer service representatives are vital to smooth communication and customer support. Their responsibilities include answering questions, resolving issues, and providing information about healthcare products, services, and policies. They handle inbound and outbound calls for healthcare providers such as hospitals, medical offices, insurance companies, clinics, and nursing homes.
Key duties include:
- Responding to inquiries: Addressing medical services, insurance claims, and product availability questions.
- Problem resolution: Helping customers navigate billing issues, scheduling conflicts, or service complaints.
- Administrative duties: Managing patient intake paperwork, scheduling appointments, and maintaining records.
- Data entry and documentation: Recording customer interactions, updating patient files, and verifying billing information.
- Policy adherence: Following scripts and guidelines to ensure accurate and compliant communication.
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National Average Salary
Healthcare customer care representative salaries vary by experience, industry, organization size, and geography. Click below to explore salaries by local market.
The average national salary for a Healthcare Customer Care Representative is:
$38,302
Healthcare Customer Care Representative Job Descriptions
A well-crafted job description is the first step when hiring a great healthcare customer care representative. Below are real-world examples to help give you the best chance of success on your recruiting journey.
Entry-level healthcare customer service representative
The representative provides a positive customer service experience that meets the needs of our patients by educating them on products and services, listening to concerns, addressing issues, and placing supply orders in a high-volume inbound call center.
Responsibilities:
- Answer customer inquiries regarding insurance claims and billing.
- Schedule appointments and manage patient reminders.
- Follow scripts to handle high call volumes professionally.
- Maintain accurate records in the CRM system.
Qualifications:
- High school diploma or GED.
- Strong communication and problem-solving skills.
- Basic computer skills (Microsoft Office, CRM software).
Healthcare customer care representative for insurance providers
ABC Insurance Company is seeking a Customer Service Representative to join our team.
Essential duties and responsibilities
- Assist customers with understanding policy coverage and filing claims.
- Resolve escalated insurance-related concerns.
- Coordinate with medical providers to verify patient eligibility.
- Update and maintain accurate insurance records.
Requirements
- Associate degree or equivalent experience.
- Familiarity with insurance terms and claim processes.
- Exceptional interpersonal and organizational skills.
Preferred
- Ability to speak Spanish or other languages in addition to English
Senior healthcare customer care representative
Responsibilities:
- Handle complex customer issues with empathy and professionalism.
- Train and mentor new team members.
- Assist with insurance claim resolutions and pre-authorization requests.
- Analyze call metrics to improve customer satisfaction.
Qualifications:
- Knowledge of HIPAA regulations and insurance policies.
- Bachelor’s degree preferred.
- 2+ years of customer service experience in a healthcare setting.
Bilingual healthcare customer care representative
Responsibilities:
- Provide support to customers in multiple languages.
- Translate healthcare documents and explain procedures.
- Assist non-English-speaking patients with navigating the healthcare system.
- Ensure culturally sensitive communication.
Qualifications:
- Fluency in English and other languages (e.g., Spanish, Mandarin).
- Experience in customer service or healthcare.
- Excellent communication skills and cultural awareness.
How to Hire a Healthcare Customer Care Rep
Consider these factors when creating a job description:
General position requirements
- What specific healthcare-related experience should the candidate have (e.g., insurance claims, patient interaction)?
- Is familiarity with medical terminology or coding required for this role?
- Does the role require bilingual capabilities, and if so, in which languages?
- Will the representative handle sensitive data (e.g., billing, insurance) that requires compliance knowledge like HIPAA training?
- Should the candidate have experience with electronic health records (EHR) or CRM systems?
Skills and abilities
- How important are multitasking and time management skills for handling high call volumes?
- Does the candidate need strong conflict resolution or de-escalation skills for managing irate customers?
- Is the ability to quickly learn and adapt to new software or systems essential for this role?
Scheduling and work environment
- What are the work hours, and are non-standard hours, such as evenings or weekends, required?
- Is this a remote or in-office position? If remote, does the candidate need specific home office equipment or internet capabilities?
- Will the representative work independently, or is collaboration with other team members a significant part of the role?
Expertise and Experience
- Should the candidate have prior experience in a call center environment, or is on-the-job training sufficient?
- Does the representative need specific certifications, such as customer service certifications or healthcare-related qualifications?
Culture fit
- Does your organization prioritize a specific communication style (e.g., empathetic, professional, or efficiency-focused)?
- Should the candidate have experience working in a fast-paced or high-pressure environment?
Long-term considerations
- Are there opportunities for growth within the role, and should the candidate demonstrate an interest in career progression?
- Should the candidate align with your organization’s values and mission, particularly in healthcare?
Recruitment methods:
1. Work with a professional recruiting firm
A staffing agency like 4 Corner Resources streamlines the process by sourcing, screening, and delivering pre-qualified candidates. This approach saves time and ensures a high-quality hire.
2. Post your opening on a top job board
Advertise on platforms like Indeed or LinkedIn, which attract millions of job seekers. This method works best if you have time before the position needs to be filled and an internal team to manage and screen applications.
3. Leverage internal resources
Use your company’s website, social media, and employee referrals to find candidates. Offer incentives for employee referrals to expand your reach.
Sample Interview Questions
- Can you describe your experience in customer service?
- How do you handle challenging or irate customers?
- Are you familiar with HIPAA regulations and why they are essential?
- Have you worked with electronic health records (EHR) or CRM systems?
- What steps would you take to resolve a customer’s billing issue?
- How do you ensure accuracy when managing sensitive healthcare information?
- Describe a time you went above and beyond for a customer.
- What do you think are the most critical skills for this role?
- Can you explain a time you worked in a fast-paced environment with tight deadlines?
- How do you prioritize tasks when managing multiple customer interactions?