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How to Become a Healthcare Customer Care Representative

Are you looking for a rewarding career in the healthcare industry where you can put your amazing customer service skills to work? A healthcare customer care representative could be the opportunity that fits your skills.

Healthcare customer care representatives typically work in call centers where they help customers understand their healthcare coverage and address any questions or concerns they have. Healthcare customer care reps need patience and solid verbal communications skills. They should be able to follow scripts to answer questions about authorization for medical treatments, co-payments, benefits, and insurance coverage. 

Healthcare customer care reps must have friendly personalities, excellent listening skills, and need to stay up-to-date on changes in insurance plans. They handle customer issues and complaints, advise them of outstanding co-payments and non-payment, and stay calm when dealing with an angry or frustrated customer. Intermediate computer skills and the ability to work in a high-stress environment are required. Healthcare customer care reps work for hospitals, medical offices, clinics, insurance companies, nursing homes, and other healthcare facilities. In a clinical setting, they may also be responsible for administrative duties. 

Sample job description

The healthcare customer care representative is responsible for providing customer service and support to healthcare customers. The representative will be responsible for responding to customer inquiries, providing information about products and services, and resolving customer issues. The representative must have excellent communication skills and be able to build positive relationships with customers. You can expect to provide customer service and support to healthcare customers, respond to customer inquiries, provide information about products and services, and resolve customer issues. If you have these skills, don’t hesitate to apply for the position at [Your Company Name]!

Typical duties and responsibilities

  • Answer incoming calls from customers
  • Assist customers with requests for information, complaints, making appointments, and resolving issues
  • Collect copays and deductible payments
  • Maintain and update customer and referral information
  • Ensure patient forms contain all necessary billing information

Education and experience

This position requires a high school diploma or equivalent, but employers often prefer candidates with an associate degree or higher.

Required skills and qualifications

  • Strong written and verbal communication skills
  • Ability to communicate calmly and diplomatically with customers, co-workers, and visitors
  • Keen attention to detail, especially involving checking forms and documents for proper information
  • Working knowledge of Microsoft Office Suite or similar software
  • Proficient in customer service
  • Knowledge of medical insurance procedures
  • Active listening and comprehension skills
  • Working knowledge of office equipment such as copiers, printers, and fax machines

Preferred qualifications

  • Excellent communication skills
  • Strong customer service skills
  • Ability to build positive relationships with customers

Typical work environment

The healthcare customer care representative typically works in an office environment. Representatives must also be able to work with people from all walks of life and be able to handle difficult customer service issues. Hours are typically Monday through Friday, 9 AM to 5 PM, but may vary depending on the company.

Typical hours

The typical work hours for a customer care representative are from 9 AM to 5 PM, if a health care clinic or facility employs them. Customer care representatives who work for insurance companies or hospitals that offer 24-hour customer service may work non-traditional shifts, including nights, weekends, and holidays.

Available certifications

A popular certification for healthcare customer care representatives is below:

  • Healthcare Customer Service Representative Certificate. Held by NWTC, this certificate will allow you to learn to provide excellent customer service in a health care setting. You’ll be instructed on how to not only meet but exceed customer needs. All courses in this certificate may be applied toward the medical assistant technical diploma program.

Career path

This position requires a high school diploma or equivalent, but employers often prefer candidates with an associate degree or higher. Successful customer care representatives can move into customer care manager positions or, in a clinical setting, move up to positions such as office manager.

US, Bureau of Labor Statistics’ job outlook

SOC Code: 43-4051

2020 Employment2,923,400
Projected Employment in 20302,888,800
Projected 2020-2030 Percentage Shift 1% decrease
Projected 2020-2030 Numeric Shift35,400 decrease

According to the customer care technology company Qualtrics, customer care in the health care space is changing. Customers in every sector of the economy are looking for more personal service, as well as 24-hour convenience. That means that many traditional tasks handled by customer care representatives, such as submitting forms and changing appointments are being automated and controlled by cloud-based patient portals to add convenience to the patient experience. However, providing personal service while a patient is receiving services in a clinic, hospital, or nursing home is now falling under the purview of a customer care representative. Tasks can include reaching out to patients to see how they’re doing and offer assistance with any potential questions or issues. Customer care representatives who work for insurance companies may see an increase in more complex customer care issues that websites and artificial intelligence (AI) cannot adequately handle, rather than more routine procedural jobs like finding provider referrals and managing patient information.