Client Service Representative I

Role Insights

The Client Service Representative I plays a critical role within the organization, serving as a central point of communication between clients, members, and internal departments. This position operates in a high-volume call center environment, requiring the ability to efficiently manage a steady flow of incoming calls while addressing a wide range of inquiries, including claims, service authorizations, and other service-related concerns.

This is a dynamic, fast-paced role that demands energy, professionalism, compassion, empathy and a strong commitment to delivering exceptional, service-focused experiences. Success in this position requires confidence in problem-solving, sound judgment, and the ability to resolve issues promptly and effectively. In addition to handling inbound calls, representatives are responsible for conducting timely follow-up outreach to ensure issues are fully resolved. Strong time management and organizational skills are essential to balance call volume with follow-up responsibilities throughout the day.

Performance in this role is measured through key performance indicators (KPIs), including call metrics, first-call resolution effectiveness, escalation rates, and overall service quality.

Primary Responsibilities

Manage a high volume of routine inbound calls from members, brokers, healthcare providers, and health plans, addressing inquiries related to claim status, eligibility, service authorizations, benefits, case management, etc.
Verify and communicate member eligibility and benefits, and provide accurate, timely information regarding access to services
Deliver claim status updates, complete check tracers, guide callers to the portal when appropriate and resolve routine inquiries during the initial call whenever possible
Research, analyze, and resolve issues related to claims, eligibility, case management, authorizations or any other customer related request, ensuring thorough and timely resolution
Conduct outbound follow-up calls, taking full ownership to ensure completion and resolution of outstanding issues
Escalate complex or unresolved issues to senior representatives (CSR II/III) or the appropriate department as needed
Accurately document all interactions, actions taken, and outcomes within CRM/EHR and proprietary systems
Monitor for trends in call types (disposition) or issues and proactively communicate observations to management
Meet or exceed established performance metrics, including call metrics, quality standards, and first-call resolution
Perform additional duties as assigned

Required Skills and Abilities

High school diploma or GED required; Associate degree or higher preferred

Minimum of 2 years of call center or customer service experience strongly preferred
At least 1 year of experience in a healthcare or medical environment preferred; working knowledge of managed care concepts (e.g., HMO, IPA structures) and HIPAA compliance requirements
Strong verbal and written communication skills with the ability to convey information clearly and professionally
Positive, professional attitude with strong interpersonal and customer service skills that include but are not limited to active listening, demonstrating empathy, upbeat tone and presence (let the caller hear your smile), professional call control, appropriate use of probing questions, reflecting understanding of request, and strong cultural sensitivity and awareness
Demonstrates critical thinking and problem-solving skills with the ability to assess situations and deliver timely, effective solutions
Excellent time management and organizational skills in a fast-paced, high-volume environment
Ability to follow scripts, standard workflows, and established procedures while maintaining service quality
Self-motivated with a strong work ethic and results-driven mindset
Proficiency in Microsoft Office applications and CRM/EHR systems
Strong data entry skills with a high level of accuracy and attention to detail
Reliable and consistent attendance with the ability to work a standard schedule (i.e. Monday–Friday, 8:00 AM – 5:00 PM)

Decision-Making & Scope of Authority

Resolves routine inquiries and standard customer issues independently with kindness, compassion and empathy
Exercises basic to moderate decision-making authority within established guidelines, scripts, and standard workflows
Follows established procedures and uses sound judgment to ensure compliance with organizational policies and regulatory requirements
Seeks guidance when needed to ensure accurate and complete resolution of customer concerns
Appropriately escalates complex, non-routine, or unresolved issues to CSR II/III or leadership as appropriate

AMM BENEFITS

When you join AMM, you’re not just getting a job—you’re getting a benefits package that puts YOU first:

Health Coverage You Can Count On: Full employer-paid HMO and the option for a flexible PPO plan.
Wellness Made Affordable: Discounted vision and dental premiums to help keep you healthy from head to toe.
Smart Spending: FSAs to manage healthcare and dependent care costs, plus a 401(k) to secure your future.
Work-Life Balance: Generous PTO, 40 hours of sick pay, and 13 paid holidays to enjoy life outside of work.
Career Development: Tuition reimbursement to support your education and growth.
Team Fun: Paid company outings and lunches because we work hard, but we also know how to have fun!

Learn more about this Employer on their Career Site