Customer Service Representative

The Customer Service Representative serves as an important point of contact for Wellvana's patients, providers, healthcare partners, and other customers. This position is responsible for providing timely, compassionate, and accurate assistance through phone, email, text, and other communication channels.

The ideal candidate is patient-focused, empathetic, organized, and comfortable working in a healthcare environment. The Customer Service Representative must be able to listen carefully, identify customer needs, resolve issues efficiently, document interactions accurately, and protect confidential health information.

This role requires strong communication skills and the ability to work collaboratively with care management, clinical, operations, provider support, and other internal teams.

Essential Responsibilities

• Serve as a professional and compassionate first point of contact for patients, providers, practices, and healthcare partners.
• Respond to customer questions and requests through telephone, email, text messaging, and other approved communication channels.
• Listen actively to understand customer concerns, needs, and questions.
• Provide accurate information regarding Wellvana services, programs, processes, appointments, care-related resources, and administrative matters within the scope of the role.
• Assist patients and customers in navigating appropriate Wellvana resources and services.
• Coordinate with internal teams, including care management, clinical operations, provider support, and administrative teams, to resolve customer issues.
• Escalate clinical, urgent, sensitive, or otherwise complex matters to the appropriate qualified team member.
• Follow established procedures for handling customer complaints, service requests, escalations, and follow-up activities.
• Document customer interactions, requests, actions taken, and resolutions accurately and promptly in applicable systems.
• Follow up with customers when necessary to ensure their questions or concerns have been appropriately addressed.
• Help customers understand next steps and connect them with the appropriate resources.
• Maintain a thorough understanding of Wellvana's programs, services, workflows, and customer-support procedures.
• Maintain professionalism and empathy when interacting with customers who may be frustrated, confused, anxious, or experiencing difficulty navigating healthcare services.
• Work closely with team members to identify recurring customer issues and opportunities to improve the customer experience.
• Maintain accurate customer information and records.
• Protect patient and customer information and follow all applicable privacy, security, HIPAA, and company requirements.
• Complete required training related to privacy, cybersecurity, compliance, and Wellvana procedures.
• Meet established service-quality, productivity, documentation, response-time, and customer-experience standards.
• Participate in team meetings, training sessions, quality-improvement initiatives, and other department activities.
• Perform other duties as assigned.

Patient and Customer Experience

The Customer Service Representative should consistently demonstrate:

• Empathy and respect for every customer.
• Patience when explaining healthcare-related information.
• Clear and professional communication.
• Active listening.
• Ownership of customer concerns.
• Appropriate follow-through.
• Respect for patient privacy and confidentiality.
• A commitment to helping patients and providers navigate healthcare more effectively.

HIPAA and Confidentiality Responsibilities

Because this position may involve access to protected health information (PHI), the Customer Service Representative must:

• Maintain strict confidentiality of patient and customer information.
• Access information only when necessary to perform assigned job responsibilities.
• Follow Wellvana's privacy, security, and information-handling procedures.
• Follow applicable HIPAA requirements and other healthcare privacy regulations.
• Never disclose protected information to unauthorized individuals.
• Properly document and report privacy or security concerns.
• Complete required HIPAA and cybersecurity training.

Qualifications

Required

• High school diploma or equivalent.
• Previous customer service, healthcare, call center, patient support, administrative, or related experience.
• Excellent verbal and written communication skills.
• Strong listening and interpersonal skills.
• Ability to communicate with patients and healthcare professionals in a clear, respectful, and compassionate manner.
• Strong problem-solving and critical-thinking skills.
• Ability to handle confidential information appropriately.
• Strong attention to detail and accurate documentation skills.
• Ability to manage multiple customer requests and priorities.
• Comfortable using computers and multiple software applications.
• Ability to work independently and collaboratively in a fast-paced healthcare environment.

Preferred

• 1–3 years of healthcare customer service or patient-support experience.
• Experience working in a medical office, health plan, healthcare organization, ACO, or value-based care environment.
• Experience with electronic health records (EHRs), CRM platforms, ticketing systems, or healthcare customer-service software.
• Knowledge of HIPAA and healthcare privacy requirements.
• Experience handling escalated customer concerns.
• Bilingual or multilingual communication skills.

Core Competencies

• Patient-centered service
• Empathy and compassion
• Active listening
• Verbal and written communication
• Problem-solving
• Conflict resolution
• Attention to detail
• Organization
• Accountability
• Confidentiality
• Teamwork
• Adaptability
• Time management
• Healthcare customer-service knowledge

Technology Skills

The Customer Service Representative should be comfortable working with:

• Customer relationship management (CRM) systems
• Electronic health record (EHR) systems, as applicable
• Customer-service/ticketing platforms
• Microsoft Office or Google Workspace
• Email and messaging platforms
• Video-conferencing and internal communication tools
• Web-based healthcare and administrative applications

Training will be provided on Wellvana-specific systems and workflows as applicable.

Performance Expectations

Performance may be evaluated using:

• Customer satisfaction and service quality
• Accuracy of customer information and documentation
• Response and resolution times
• Successful resolution or appropriate escalation of customer issues
• Productivity and case-management metrics
• Compliance with privacy, HIPAA, security, and company policies
• Follow-up completion
• Communication and teamwork
• Attendance and reliability
• Contribution to continuous improvement

Working Environment

This position may be performed in an office, hybrid, or remote environment depending on business requirements.

The role may involve:

• Frequent telephone and electronic communication.
• Extended computer use.
• High-volume customer interactions.
• Sensitive or emotionally difficult customer conversations.
• Collaboration with healthcare professionals and internal departments.
• Handling confidential healthcare information.

Schedule

Schedule: [Insert Schedule]

The position may require occasional evenings, weekends, holidays, or schedule flexibility depending on customer and business needs.

Compensation and Benefits

Salary: [Insert Salary Range]

Benefits may include applicable healthcare coverage, paid time off, retirement benefits, employee programs, professional-development opportunities, and other benefits offered by Wellvana. Eligibility is subject to company policies and applicable plan requirements.

Equal Employment Opportunity

Wellvana is committed to providing equal employment opportunities to qualified individuals and maintaining a workplace where employees are treated with professionalism and respect.