Customer Service Representative

Position Overview

This is an hourly, remote work-from-home position supporting Utilization Management operations. Candidates must be flexible and available to work any assigned shift, which may extend until 7:00 PM CST / 8:00 PM EST, with the possibility of working a weekend or holiday shift based on business needs,with occasional weekend or holiday hours based on business needs.

During the first 60 days of employment , time off is not permitted due to required training and onboarding activities. Consistent attendance and punctuality are critical to success in this role, as team members must be available and ready to take calls throughout their scheduled shifts to ensure timely support for providers and members.

Training Schedule

The first month consists of mandatory training conducted Monday through Friday from 8:00 AM to 4:30 PM CST .

Employment Opportunity

This position offers the potential to convert from temporary to permanent employment based on performance, attendance, and business needs.

Position Summary

The UM Administration Coordinator 2 plays a key role in supporting the administration of utilization management services for healthcare providers. This position is responsible for performing advanced administrative, operational, and customer service functions while exercising independent judgment and problem-solving skills while in a fast-paced metric driven environment.

The role primarily supports provider inquiries through inbound phone calls, guiding callers through utilization management processes while ensuring accuracy, compliance, and efficient access to care for Humana members. Representatives must effectively navigate multiple systems, follow established workflows, and apply critical thinking to resolve issues and support timely service delivery.

In addition, representatives will be trained to support multiple plan types and may have opportunities to transition into back-office functions based on performance and business needs. Success in this role requires consistently meeting key performance expectations, including adherence, quality, productivity, and attendance standards, while maintaining a strong commitment to service excellence and operational efficiency.

Key Responsibilities

As a Utilization Management Coordinator 2, you will:

• Manage prior authorization inquiries and requests from healthcare providers.
• Handle approximately 30 to 50 inbound calls per day in a fast-paced, performance-based environment.
• Research and review information to determine whether requested services meet medical necessity guidelines.
• Assist providers in navigating the authorization process to help ensure members receive appropriate care while minimizing unnecessary out-of-pocket costs.
• Accurately document activities and maintain compliance with established procedures.
• Utilize multiple systems simultaneously while adhering to detailed process flows.
• Potentially support member calls as business needs evolve.
• Meet productivity, quality, and customer service expectations.

Scheduled breaks and meal periods are assigned to ensure adequate staffing and maintain service levels for providers and members.

Required Qualifications

Experience & Skills

• Minimum of 2 years of customer service experience , preferably within healthcare, insurance, or health services.
• Strong customer service mindset and genuine enjoyment in helping providers and Medicare members over the phone.
• Ability to manage a high-volume call environment, handling approximately 30 to 50 calls daily.
• Typing proficiency of at least 30 words per minute .
• Ability to learn and retain complex information through virtual training.
• Comfortable following detailed multi-step procedures while maintaining accuracy.
• Analytical, problem-solving, and organizational skills.
• Ability to work independently with minimal supervision.
• Excellent verbal and written communication skills.
• Active listening capabilities.
• High attention to detail and commitment to quality.
• Demonstrated technical aptitude and ability to navigate multiple computer systems simultaneously.
• Experience using Microsoft Office applications and comfortable utilizing toolbars, menus, and system features to efficiently locate, retrieve, and manage documents.
• Strong work ethic and commitment to attendance and reliability.
• Passion for improving customer experiences and supporting healthcare access….