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Customer Service Representative

Position Title

Customer Service Representative (CSR)


Position Description

Under general supervision, uses specialized health plan knowledge to provide professional, efficient, and customer-focused service in support of the health plan memberinquiries involving claim, benefit, membership, and/or billing.


Creates a positive first impression by providing knowledgeable answers to questions and directs callers appropriately. 



  • Provides accurate, timely, and professional responses via telephone, electronic mail, or online chat to plan members or other external customers.

  • Uses appropriate systems platforms to research and resolve plan member or customer inquiries and issues.  

  • Requests required data and information from internal business partners as necessary to respond to customer inquiries.

  • Follows department/corporate inquiry documentation and reporting policies and procedures.

  • Meets daily, weekly and monthly call center performance goals in respect to volume, metrics and service levels and quality.  

  • Interacts with others inside and outside the organization to resolve the inquiry/claim related problems.

  • Redirects misdirected calls in an efficient and professional manner.

  • Other responsibilities as may be required.



Basic Qualifications

  • High school graduate or GED equivalent required. 

  • Prior Customer Service / Call Center experience.

  • Exceptional communication skills and the ability to understand complex situations and to effectively handle escalated customer concerns.

  • Ability to type a minimum of 35 words per minute.

  • Analytical skills and the ability to read and interpret data.

  • Demonstrated problem solving skills.

  • Detail oriented and well organized.

  • Ability to work independently and as a part of a team

  • Ability to operate computer programs - Microsoft Word, Microsoft Excel, Microsoft PowerPoint

Preferred Qualifications

  • Knowledge of managed care processes and health insurance coverage preferred

  • Specific prior Customer Service / Call Center experience in a Managed Care Organization preferred

  • Bilingual in Spanish and English preferred 


Classification:  Full-time with Benefits

Work Location: Detroit, MI

Work Hours:  Monday – Friday, 7:00AM – 4:00PM

Hours per week:  40

Position Requisition #: 5187

Date Posted: April 19, 2020

Naya Advisory Services, Inc. is an equal opportunity employer committed to a diverse and inclusive workplace.

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