Job Information

Evolent Health Representative, Customer Service I (MUST RESIDE IN NY - FULLY REMOTE) in Dover, Delaware

Your Future Evolves Here

Evolent Health has a bold mission to change the health of the nation by changing the way health care is delivered. Evolenteers make a difference wherever they are, whether it is at a medical center, in the office, or while working from home across 48 states. We empower you to work from where you work best, which makes juggling careers, families, and social lives so much easier. Through our recognition programs, we also highlight employees who live our values, give back to our communities each year, and are champions for bringing their whole selves to work each day. If you’re looking for a place where your work can be personally and professionally rewarding, don’t just join a company with a mission. Join a mission with a company behind it.

Why We’re Worth the Application:

  • We continue to grow year over year.

  • Recognized as a leader in driving important diversity, equity, and inclusion (DE&I) efforts (https://www.evolenthealth.com/diversity) .

  • Achieved a 100% score two years in a row on the Human Rights Campaign's Corporate Equality Index (https://www.evolenthealth.com/about-us/press-releases/9327/evolent-health-named-one-of-the-best-places-to-work-for-lbgtq%2B-equality-for-second-consecutive-year) recognizing us as a best place to work for LGBTQ+ equality.

  • Named to Parity.org’s list of the best companies for women to advance for 3 years in a row (https://www.evolenthealth.com/about-us/press-releases/9328/evolent-health-named-to-parity.org%E2%80%99s-best-companies-for-women-to-advance-list-2022) (2020, 2021 and 2022).

  • Continue to prioritize the employee experience and achieved a 90% overall engagement score on our employee survey in May 2022.

  • Publish an annual DE&I report (https://dev.evolenthealth.com/sites/default/files-public/Evolent%20Health%202020%20DE%26I%20Annual%20Report.pdf) to share our progress on how we’re building an equitable workplace.

What You’ll Be Doing:

Our customer service team offers candidates the opportunity to make a meaningful impact by providing exceptional support to our valued customers, fostering a sense of job satisfaction through problem-solving and positive interactions. Our team values collaboration, continuous learning, and a customer-centric approach, ensuring that every team member contributes to providing better health outcomes.

Collaboration Opportunities:

  • Customer Service Representatives (CSR’s) will be working with and providing support to health plan members, providers and/or their representatives. Leadership rewards and recognizes CSR’s regularly for performance in an environment that challenges while providing clear direction and support to foster success in the role.

What You Will Be Doing:

  • Answer and manage inbound inquiries regarding health plan benefits and claims, eligibility, medical and other healthcare procedures, billing and payments and other related topics from customers in a prompt, courteous manner. Conduct out-bound and/or return calls to customers as necessary.

  • Ask appropriate questions and listen actively to identify specific questions or issues to provide appropriate response and type of assistance the customer needs while documenting relevant information in a clear and concise manner in computer systems.

  • Communicate and partner with customers tactfully and empathetically to resolve issues, using clear language translating healthcare-related jargon and complex processes into simple, step-by-step instructions customers can comprehend and act upon.

  • Handle and process customer complaints/ grievances while applying appropriate conflict management skills to de-escalate potentially stressful situations.

  • Meet the performance goals established for the position in the areas of efficiency, accuracy, quality, member satisfaction and attendance. Adhere to all applicable department, organization and/or regulatory policies and procedures.

  • Read, comprehend, and verbalize processes and procedures of the organization and of health insurance coverage.

  • Training includes a virtual classroom environment with trainers who have experience working within the Evolent Customer Service Operations (CSO) call center. Training Hours are 8:00am – 4:30pm CT Monday–Friday (for approximately 6-weeks). Trainees will be required to attend the entirety of training, successfully complete the required training schedule, and demonstrate proficiency of the material at the end of training.

  • Hours of Operation: 6 days a week, 8:00am – 9:00pm ET (hours depend on the client to which you are assigned, and your shift will be determined during training if not before).

Qualifications Required and Preferred:

• Bilingual in Spanish & English (validated via bilingual assessment upon offer acceptance) - Preferred

• High school diploma or GED - Required

• At least 1 year call center experience - Required

• Ability to handle a heavy call volume of 50-100 calls daily - Required

• Demonstrated ability in using computer and Windows PC applications, which includes strong keyboard and navigation skills, ability to type 35 WPM and learn new computer programs - Required

• Ability to work regularly scheduled shifts within hours of operation including the training period, where lunches and breaks are scheduled, with the flexibility to adjust daily schedule, and work over-time and/or weekends, as needed - Required

• Demonstrated ability to take an educative approach, listen skillfully, collect relevant information, determine immediate requests and identify the current and future needs of the customer, answering questions and informing of health plan policies, procedures, or decisions - Required

• Ability to maintain strict confidentiality of protected health information - Required

• This is a work from home position, which requires a quiet, private workspace without noise and distractions, and reliable internet connectivity provided through a wired connection with a minimum of 100 MBPS speed. A mobile, hot spot, or WiFi connection is NOT acceptable - Required

• 2+ years at a health plan, TPA or related call center setting - Preferred

• Knowledge of managed care, Commercial, Marketplace, Medicaid and/or Medicare programs; knowledge of medical policy benefits and exclusions - Preferred

Technical Requirements:

We require that all employees have the following technical capability at their home: High speed internet over 10 Mbps and, specifically for all call center employees, the ability to plug in directly to the home internet router. These at-home technical requirements are subject to change with any scheduled re-opening of our office locations.

Evolent Health is an equal opportunity employer and considers all qualified applicants equally without regard to race, color, religion, sex, sexual orientation, gender identity, national origin, veteran status, or disability status.

Compensation Range: The minimum salary for this position is $17.50-18.50, plus benefits. Salaries are determined by the skill set required for the position and commensurate with experience and may vary above and below the stated amounts.

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For more insights about Evolent Health, click on Life At Evolent (https://www.evolenthealth.com/about-us/life-at-evolent) to learn more!