Remote Healthcare Customer Service Representative – Managed Care Support, Member Outreach, and Utilization Review (Fully Remote, US‑Based)

About careerzynith

careerzynith is a leading provider of innovative health‑technology solutions that empower millions of members across the United States to navigate the complexities of managed care with confidence. Our mission is to blend compassionate customer service with rigorous clinical expertise, creating a seamless experience for patients, providers, and payers alike. As a remote‑first organization, careerzynith invests heavily in cutting‑edge digital platforms, robust data security, and a culture that values flexibility, continuous learning, and employee well‑being. Join a team that is reshaping the future of healthcare delivery while enjoying the freedom to work from anywhere in the U.S.

Position Overview

careerzynith is seeking a highly motivated Remote Healthcare Customer Service Representative to support our managed‑care operations. In this role, you will engage directly with Medicare beneficiaries, conduct high‑volume outreach, and document interactions within our secure Virtual Health platform. Your work will directly influence member satisfaction, compliance metrics, and overall quality of care. This is a contract position for three months with strong potential for extension or conversion to a permanent role based on performance.

Key Responsibilities

• Member Outreach & Communication: Initiate 80‑120 outbound calls per day to Medicare members, providing clear information on benefits, care coordination, and utilization review processes.
• Utilization & Coordinated Care Support: Assist in activities related to the medical and psychological aspects of utilization, ensuring members receive appropriate services in a timely manner.
• Accurate Documentation: Record every interaction in the Virtual Health system, maintaining a 100% compliance rate for assigned members.
• Data Management: Consistently update Excel spreadsheets with member assignments, call outcomes, and follow‑up actions.
• Performance Monitoring: Meet or exceed engagement targets (≥80% monthly) and maintain an audit score of at least 90%.
• Collaboration: Communicate regularly with supervisors and cross‑functional teams to resolve member issues and improve processes.
• Compliance & Security: Operate within HIPAA guidelines, using a hard‑wired internet connection and a dedicated home workspace.
• Continuous Improvement: Provide feedback on call scripts, workflow efficiencies, and member experience enhancements.

Essential Qualifications

• 2–3 years of experience in a managed‑care setting, medical office, or similar healthcare environment, with demonstrated medical administration duties.
• Thorough knowledge of customer service best practices, utilization review, and claims processing within a managed‑care framework.
• Proficiency with Microsoft Office Suite, especially Excel (advanced functions, pivot tables, and data validation).
• Strong grasp of medical terminology and the ability to translate complex concepts into layperson language.
• Exceptional time‑management and organizational skills; ability to juggle high call volumes while maintaining accuracy.
• High school diploma or equivalent; additional certifications in health administration or related fields are a plus.
• Reliable high‑speed internet (hard‑wired) and a quiet, private workspace compliant with HIPAA standards.

Preferred Qualifications & Skills

• Associate’s or Bachelor’s degree in Health Administration, Nursing, or a related discipline.
• Experience with electronic health record (EHR) systems or proprietary health‑tech platforms.
• Demonstrated success in meeting high‑volume outbound call targets (100+ calls per day).
• Strong written and verbal communication skills, with a focus on empathy and active listening.
• Ability to quickly learn and adapt to new software tools and workflow processes.
• Previous experience working remotely in a regulated environment (HIPAA, GDPR, etc.).

Core Competencies for Success

• Customer‑Centric Mindset: Prioritize member needs, ensuring each interaction adds value and builds trust.
• Analytical Thinking: Interpret member data, identify gaps in care, and recommend appropriate next steps.
• Attention to Detail: Maintain flawless documentation and adhere strictly to compliance standards.
• Resilience & Stamina: Thrive in a fast‑paced environment while handling repetitive tasks with enthusiasm.
• Team Collaboration: Share insights with supervisors and peers to continuously improve service delivery.

Compensation, Benefits, and Perks

careerzynith offers a competitive hourly rate of $20.00, with performance‑based incentives for exceeding engagement and audit targets. As a remote employee, you will enjoy:

• Flexible work hours within the 8:30 – 5:30 EST window, allowing for a balanced personal and professional life.
• Access to a comprehensive health, dental, and vision benefits package after the probationary period.
• Paid time off accruals that increase with tenure, plus company‑wide holidays.
• Professional development stipend for certifications, webinars, or courses relevant to healthcare administration.
• Employee Assistance Program (EAP) offering counseling, financial advice, and wellness resources.
• Technology allowance to ensure you have a reliable laptop, headset, and ergonomic home office setup.

Career Growth & Learning Opportunities

careerzynith is committed to nurturing talent from within. Successful remote healthcare customer service professionals often progress to roles such as:

• Senior Utilization Review Analyst
• Member Services Team Lead
• Quality Assurance Specialist
• Healthcare Operations Manager
• Product Training & Implementation Coordinator

Our structured mentorship program pairs you with seasoned industry experts, while quarterly learning sessions keep you abreast of emerging trends in telehealth, value‑based care, and regulatory compliance.

Work Environment & Culture at careerzynith

At careerzynith, we believe that a supportive, inclusive, and innovative culture drives exceptional performance. Our remote‑first model is built on:

• Transparent Communication: Regular virtual town halls, team huddles, and one‑on‑one check‑ins with leadership.
• Diversity & Inclusion: A workforce that reflects the communities we serve, with employee resource groups and inclusive policies.
• Well‑Being Focus: Access to mental‑health resources, virtual fitness classes, and a “no‑meeting” day each month to recharge.
• Recognition Programs: Monthly awards for top performers, peer‑nominated accolades, and spot bonuses for outstanding service.
• Innovation Labs: Opportunities to contribute ideas that shape new product features and improve member experiences.

Application Process

If you are passionate about delivering compassionate, high‑quality support to Medicare members and thrive in a dynamic, remote environment, we want to hear from you. To apply, click the link below and submit your resume, cover letter, and a brief statement describing a time you successfully managed a high‑volume outreach campaign while maintaining compliance standards.

Apply Now – Join careerzynith!

Closing Statement

careerzynith is more than a workplace; it’s a community of forward‑thinking professionals dedicated to improving health outcomes across the nation. Your expertise in healthcare customer service can make a tangible difference in the lives of thousands of members. Take the next step in your career journey with careerzynith—where your skills are valued, your growth is supported, and your impact is measurable.