St. Luke's Health System · 4 hours ago
Customer Service Representative - St. Luke's Health Plan - 150982
Boise, ID
Full-time
Onsite
New Grad, Entry Level
0+ years expSt. Luke's Health System is dedicated to caring for the communities it serves, and they are seeking a Customer Service Representative for the St. Luke’s Health Plan. This role is the first point of contact for members, providing outstanding customer service and support while handling inquiries and assisting with benefit-related questions.
Health CareHospitalNon ProfitPrimary and Urgent Care
Responsibilities
Serves as the primary point of contact for members contacting the call center with inquiries, concerns, or requests for assistance. Listens actively to members’ needs and concerns, demonstrating empathy and understanding, and provides accurate and timely information and assistance. Handles a variety of member interactions, including but not limited to phone calls, emails, portal inquiries, and social media inquiries, with professionalism and courtesy
Utilizes knowledge of insurance benefits across multiple lines of business, including individual on and off exchange, small group, large group, self-funded, and Medicare Advantage plans, to assist members with benefit-related questions and inquiries. Explains coverage details in a clear and understandable manner, helping members make informed decisions about their healthcare coverage
Assists members in understanding how their medical claims were processed and how their insurance benefits were applied. Explains complex billing statements, EOBs (Explanation of Benefits), and claims processing terminology in a clear and comprehensible manner. Provides detailed information on deductible, copayment, coinsurance, and out-of-pocket expenses, helping members understand their financial responsibility. Collaborates with claims department as needed to address any discrepancies or concerns regarding claim processing and benefit application
Investigates and troubleshoots member issues, resolving problems and concerns within the scope of the role, and escalating to appropriate resources when not. Escalates complex or unresolved issues to the Customer Service Manager or other designated contact for additional assistance with resolution. Documents all interactions and resolutions accurately and comprehensively in the appropriate systems
When appropriate, educates members on their appeal rights, explaining the process for initiating an appeal or grievance and the timeline for resolution. Provides education on the types of issues that can be appealed, and the documentation required to support an appeal. Clarifies the steps involved in the appeals process, including how to submit an appeal, the review and decision-making process, and potential outcomes
Adheres to all applicable laws, regulations, and industry standards including HIPAA guidelines
Participates in quality assurance initiatives to ensure accuracy and consistency in customer service and appeals and grievance handling, including HIPAA guidelines
Stays informed about changes in healthcare regulations, insurance policies, and industry trends through ongoing training and professional development opportunities
Perform other duties and responsibilities as assigned
Qualification
Required
High School diploma or equivalent
0 years relevant experience
Excellent communication skills
Attention to detail
Thorough understanding of the St. Luke's Health Plan's products and services across various lines of business
Ability to handle inquiries and assist with benefit-related questions
Ability to explain coverage details in a clear and understandable manner
Ability to assist members in understanding how their medical claims were processed
Ability to explain complex billing statements, EOBs, and claims processing terminology
Ability to investigate and troubleshoot member issues
Ability to document all interactions and resolutions accurately
Ability to educate members on their appeal rights and the appeals process
Adherence to all applicable laws, regulations, and industry standards including HIPAA guidelines
Participation in quality assurance initiatives
Staying informed about changes in healthcare regulations, insurance policies, and industry trends
Benefits
On-site massages
On-site counseling via our Employee Assistance Program
Access to the Personify Health Wellness tool
Other formal training and career development offerings
Company
St. Luke's Health System
St. Luke's Health System is a healthcare facility offering internal medicine and urgent care services.
10001+ employees
H1B Sponsorship
St. Luke's Health System has a track record of offering H1B sponsorships. Please note that this does not
guarantee sponsorship for this specific role. Below presents additional info for your
reference. (Data Powered by US Department of Labor)
Distribution of Different Job Fields Receiving Sponsorship
Represents job field similar to this job
Trends of Total Sponsorships
2025 (4)
2024 (9)
2023 (7)
2022 (1)
2021 (7)
2020 (3)
Funding
Current Stage
Late StageLeadership Team
Kate Fowler, FACHE, CPA
SVP, Chief Financial Officer
Dani Jones, M.Coun
Chief Operating Officer, Health Partners
Recent News
HealthCareIT News
2025-11-21
Company data provided by crunchbase