Type: Full-time

Experience Level: At least one year in a call center customer service role. Health/Insurance background is preferred, though not required.

Location: Remote – Florida, USA

SUMMARY

Antidote Health's mission is to redefine healthcare by providing affordable, high-quality, accessible care and insurance products. The Customer Success Agent plays a key role in achieving this mission by delivering exceptional support to our health plan members, telehealth users, brokers, B2B customers.

We're seeking enthusiastic individuals with experience in healthcare customer service, particularly within the health insurance industry, to elevate and distinguish the customer experience. Our Customer Success Agents are responsible for delivering accurate, timely, and valuable information to members and customers, ensuring a seamless and compliant experience in a fast-paced inbound and outbound phone, chat, and email Customer Support Center.

ESSENTIAL DUTIES AND RESPONSIBILITIES

Handles customer inquiries through calls, chats, and emails, acting as the main point of contact for support and resolving issues.
Builds and maintains brand affinity by addressing questions, concerns, and complaints professionally while maintaining confidentiality in compliance with HIPAA guidelines.
Interprets and explains Antidote HMO insurance plans, benefits, enrollment processes, claims, EOBs, PCP selection, and referral/authorization for medical services, prescriptions, and other ancillary services (dental and vision).
Serves as an advocate between customers and network providers or other Antidote departments.
Assists in conducting customer satisfaction surveys and reports (CAPHS, QHP Enrollee Survey).
Processes premium payment and reconciles and corrects payment discrepancies.
Manages and updates member information in the customer relationship management (CRM) database.
Identifies, addresses, and documents member and customer complaints, grievances and appeals, determines the appropriate action, follows up to ensure resolution and monitors trends to optimize customer satisfaction and remediate recurring issues in accordance with NCQA and regulatory processes and timelines.
Provides outreach calls to members and customers for issue resolution and follow-up.
Processes voicemail returns.
Provides support for member and broker portals.
Coordinates translation services for members in accordance with Antidote’s Language Assistance Program.
Attend 100% of trainings, and the first 90 days of employment.
Performs other duties as assigned.

QUALIFICATIONS

The ideal candidates for this position are highly motivated and dedicated and should possess the below qualities:
High school diploma or GED
Minimum one (1) year of experience working in a call center in insurance managed care, with a preference for HMO experience
Basic understanding and ability to apply Centers for Medicare and Medicaid (CMS) regulatory requirements and standard operating procedures
Excellent oral and written communication skills
Strong organizational abilities and interpersonal skills
Ability to work flexible schedules, strong analytical and problem-solving skills, and the ability to multitask effectively
Dependable in completing assignments and maintaining attendance
Ability to type at a speed of 35-40+ WPM with an accuracy of 90% or higher
Intermediate to advanced skills in Microsoft Office (Word, Excel, Outlook), with the ability to troubleshoot and resolve general technical issues
Willingness to work any 8-hour shift schedules during business hours, with occasional overtime, weekends, and holidays as needed
Bilingual (English/Spanish) preferred
Experience in provider and facility credentialing is a plus

WORK SHIFTS AVAILABLE

Shift flexibility is required. Shift availability is based on staffing needs, with no guaranteed shifts.

Available shift options:

Pre-shift: 6:00 AM - 2:30 PM EST
Morning shift: 8:00 AM - 4:30 PM EST
Mid-shift: 11:00 AM – 7:00 PM EST
Evening shift: 5:00 PM - 1:00 AM EST
Overnight shift: 1:00 AM EST – 6:00 AM EST

Available days of the week:

Sunday - Thursday
Tuesday - Saturday
Friday – Monday

CERTIFICATES, LICENSES, REGISTRATIONS

A Health Agent license is a plus but not required.

WORK ENVIRONMENT

This is a remote position.
Must have a quiet, distraction-free workspace to perform duties effectively from home. Work location must be secure and private to maintain HIPAA compliance.
To ensure Home associates’ ability to work effectively, the self-provided internet service of Home or Hybrid Home/Office associates must meet the following criteria:
At minimum, a download speed of 25 Mbps and an upload speed of 10 Mbps is recommended; wireless, wired cable or DSL connection is suggested
Office equipment will be supplied.

TRAINING EXPECTATIONS

You will attend a minimum 4-5 week remote training program.
Attendance is mandatory for the full training program.
Training hours: Monday through Friday, 9:00 AM - 4:30 PM EST.
You will be required to take regular open-book competency and retention exams during all weeks of training, with a passing grade of 90% or above.
We request no time off within the first 120 days of employment except in emergencies.

Antidote Health

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Customer Success Agent