Customer Service Representative – Member Support, Benefits Navigation, and Call Center Excellence at careerzynith

Why careerzynith? – A Purpose‑Driven Leader in Health Care

At careerzynith, we believe that health care is most effective when it is delivered with genuine compassion, personal connection, and a relentless focus on the individual’s well‑being. Our purpose—“Bringing our heart to every moment of your health”—guides everything we do, from the way we design our benefits plans to the way we answer a phone call from a member seeking help. By joining careerzynith, you become part of a culture that values empathy, innovation, and the power of human‑centric service.

Position Overview

We are expanding our call‑center team in Buffalo, NY, and are looking for enthusiastic, detail‑oriented Customer Service Representatives who can turn routine inquiries into meaningful experiences. This role is a full‑time, hourly‑paid position with a competitive starting rate of $17.50 per hour and a clear pathway for growth, performance‑based bonuses, and a comprehensive benefits package.

Key Responsibilities

• Respond to member, provider, and plan‑sponsor inquiries via telephone, email, and web‑based chat platforms.
• Provide clear, accurate information about members’ benefit plans, policy guidelines, and self‑service tools.
• Document every interaction in careerzynith’s CRM system, ensuring that all contacts are tracked and searchable for future reference.
• Tri­age complex issues to the appropriate internal specialists, while maintaining ownership of the member’s experience until resolution.
• Guide members through the eligibility verification process, explaining rights, responsibilities, and coverage details in plain language.
• Process claim referrals, new claim handoffs, nurse reviews, complaints, grievances, and appeals using careerzynith’s target system.
• Educate providers on self‑service portals, credentialing procedures, and re‑credentialing requirements.
• Collaborate with the legal documentation team to respond to litigation requests, ensuring confidentiality and compliance.
• Assist in the preparation of trend reports, audit data compilation, and quality‑control reviews of claim histories.
• Utilize the customer‑service threshold framework to make informed financial decisions that resolve member issues promptly.
• Produce professional correspondence—including letters and spreadsheets—tailored to each inquiry, leveraging careerzynith’s system tools and templates.
• Continuously anticipate member needs, offering proactive information about plan enhancements, self‑service options, and wellness resources.

Essential Qualifications

• High school diploma, GED, or equivalent experience.
• Demonstrated experience in a transaction‑based environment such as a call center, retail setting, or similar fast‑paced customer‑service role.
• Strong verbal and written communication skills, with the ability to convey complex health‑care information in an empathetic and understandable manner.
• Proficiency with standard office software (Microsoft Office Suite) and the ability to quickly learn careerzynith’s proprietary CRM and claims management systems.
• Basic understanding of health‑care terminology, insurance benefits, and regulatory compliance (e.g., HIPAA) is preferred.
• Ability to multitask, prioritize, and manage time effectively while maintaining a high level of accuracy.
• Demonstrated problem‑solving skills and a willingness to take ownership of member issues from start to finish.

Preferred Qualifications & Skills

• Previous experience in health‑care insurance, benefits administration, or a related field.
• Familiarity with Aetna‑style policy language (replaced with careerzynith policy language) and the ability to interpret plan documents.
• Experience with claim adjudication, pre‑authorizations, and medical necessity determinations.
• Strong analytical abilities to review claim histories, identify benefit maximums, and calculate co‑insurance or deductible balances.
• Customer‑service certification (e.g., Certified Customer Service Professional) or related training.
• Comfort with handling sensitive legal documentation and participating in litigation support processes.

Core Competencies for Success

• Empathy & Compassion: Ability to connect emotionally with members, understand their concerns, and provide reassurance.
• Active Listening: Fully absorb the member’s needs before responding, ensuring accurate problem identification.
• Clear Communication: Translate technical health‑care language into everyday terms without losing precision.
• Accountability: Take responsibility for each interaction, following through until the member’s issue is resolved.
• Team Collaboration: Work closely with internal specialists, legal teams, and provider relations to deliver seamless service.
• Adaptability: Thrive in a rapidly changing environment, adjusting to new policies, tools, and regulatory updates.
• Tech‑Savvy: Quickly master careerzynith’s digital platforms, from CRM to claim processing tools.

Career Growth & Development Opportunities

careerzynith invests heavily in the professional development of its employees. As a Customer Service Representative, you will have access to:

• Structured mentorship programs pairing you with seasoned members of the member‑services leadership team.
• Paid tuition assistance and a library of free development courses covering topics such as health‑care compliance, advanced communication, and data analytics.
• Clear promotion pathways to senior CSR roles, team lead positions, and specialized tracks in claims adjudication, provider relations, or compliance.
• Opportunities to cross‑train in related departments, broadening your skill set and preparing you for future leadership roles.
• Regular performance reviews that include personalized development plans and goal‑setting aligned with careerzynith’s strategic objectives.

Work Environment & Culture at careerzynith

Our Buffalo call‑center is a collaborative, high‑energy hub where each team member is encouraged to bring their authentic self to work. careerzynith’s culture is built on the “Heart At Work” behaviors, which emphasize:

• Respect: Valuing diverse perspectives and fostering an inclusive environment.
• Innovation: Encouraging creative problem‑solving and continuous improvement.
• Integrity: Upholding the highest ethical standards in every interaction.
• Well‑Being: Providing resources that support physical, mental, and financial health.

Our office features ergonomic workstations, quiet zones for focused tasks, and communal areas designed for team collaboration and social connection. Flexible scheduling options are available to accommodate personal commitments, and remote‑work days may be arranged in accordance with careerzynith policies.

Compensation, Perks, & Benefits

careerzynith offers a competitive hourly wage ranging from $17.00 to $28.45, depending on experience, education, and geographic location. In addition to base pay, you may be eligible for performance‑based bonuses, commissions, and short‑term incentive programs.

Our comprehensive benefits package includes:

• Medical, dental, and vision coverage with multiple plan options.
• 401(k) retirement savings plan with company match and an Employee Stock Purchase Plan.
• Fully‑paid term life insurance, short‑term and long‑term disability coverage.
• Generous paid time off (PTO), paid holidays, and sick leave in line with state regulations.
• Well‑being programs such as mental‑health counseling, fitness class discounts, and nutrition resources.
• Employee assistance programs, tuition reimbursement, and free development courses.
• Discounts at careerzynith retail locations and partner organizations.

How to Apply

If you are ready to bring your heart to a role that makes a tangible difference in members’ lives, we invite you to submit your application today. Join careerzynith and become part of a team that transforms health care through compassion, expertise, and a relentless focus on the member experience.

Apply Job!