What Does a Healthcare Customer Care Representative Do?
A healthcare customer care representative serves as the front line of communication between patients, healthcare providers, and insurance carriers. These professionals typically work in call centers, hospitals, clinics, or third-party service providers, handling inquiries via phone, email, chat, or patient portals. They assist with tasks such as scheduling appointments, verifying insurance coverage, processing billing questions, and guiding patients through benefits and services. Because they work with protected health information (PHI), healthcare customer care reps must follow strict privacy protocols and adhere to HIPAA guidelines.
What sets this role apart from traditional customer service is the sensitivity and complexity of healthcare. Patients often contact reps during times of stress, pain, or confusion, requiring the representative to demonstrate empathy, patience, and clarity. They must translate medical jargon into everyday language, resolve issues without compromising patient care, and sometimes de-escalate emotionally charged situations. Successful representatives strike a careful balance between efficiency and compassion, helping patients navigate the healthcare system with confidence while ensuring regulatory compliance and service quality.
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Healthcare Customer Care Representative Core Responsibilities
- Answer inbound calls, emails, or chats related to appointments, billing, insurance, or medical services
- Schedule, reschedule, or cancel patient appointments using electronic health record (EHR) systems
- Verify insurance coverage and benefits, and update patient records as needed
- Provide accurate information regarding medical procedures, office policies, and service availability
- Resolve billing issues, explain account balances, and process payments when authorized
- Escalate complex issues to clinical or billing teams, following established workflows
- Maintain confidentiality and compliance with HIPAA and all privacy regulations
- Track and document all interactions using customer relationship management (CRM) or healthcare-specific platforms
- Monitor and meet performance metrics such as average handle time and customer satisfaction scores
- Assist with outbound communication campaigns such as appointment reminders or service follow-ups
Required Skills and Qualifications
Hard skills
- Proficiency in using EHR systems such as Epic, Cerner, or Athenahealth
- Knowledge of medical terminology and insurance processes
- Strong data entry and record-keeping accuracy
- Familiarity with HIPAA compliance and patient privacy standards
- Basic math skills for billing and payment processing
- Experience using CRM or call center software
Soft skills
- Clear and compassionate communication
- Patience and emotional intelligence under stress
- Strong problem-solving abilities
- Active listening and attention to detail
- Multitasking and time management
- Ability to remain calm and professional during difficult conversations
Education
- High school diploma or equivalent required
- Associate’s degree in healthcare administration or related field preferred
Certifications
- Certified Medical Administrative Assistant (CMAA) or Certified Healthcare Customer Service Representative (CHCSR) may be required or preferred, depending on the employer
- Additional recommended certifications include HIPAA Awareness Training and Customer Service Excellence certifications
Preferred Qualifications
- Bilingual proficiency, especially in Spanish, is highly valued
- Previous experience in a healthcare call center environment
- Familiarity with Medicare, Medicaid, and private payer systems
- Experience handling high call volumes or working in a fast-paced setting
- Understanding of patient scheduling optimization tools or automated phone systems
National Average Salary
Healthcare customer care representative salaries vary by experience, industry, organization size, and geography. Click below to explore salaries by local market.
The average national salary for a Healthcare Customer Care Representative is:
$38,302
Sample Job Description Templates for Healthcare Customer Care Representatives
Entry-Level Healthcare Customer Care Representative
Position Overview
We are seeking a dependable and compassionate Entry-Level Healthcare Customer Care Representative to join our patient support team. This role is ideal for individuals starting their career in healthcare or customer service. You’ll be the first point of contact for patients and providers, helping with scheduling, insurance verification, and general inquiries. Comprehensive training is provided to ensure your success in delivering exceptional support while maintaining compliance with HIPAA regulations.
Responsibilities
- Answer incoming calls, chats, and emails related to patient services
- Schedule, reschedule, and cancel appointments in the EHR system
- Verify insurance eligibility and collect required documentation
- Update and maintain accurate patient records
- Assist with basic billing questions or direct to the appropriate department
- Follow scripted responses for compliance and customer service consistency
- Maintain confidentiality in handling protected health information
- Meet or exceed key performance metrics, including call quality and response time
Requirements
Hard skills
- Basic knowledge of office software and data entry tools
- Ability to learn EHR platforms and scheduling software
- Familiarity with phone systems or customer service software
Soft skills
- Clear verbal and written communication
- Positive, patient-focused demeanor
- Willingness to learn and adapt
- Strong attention to detail
- Ability to remain calm under pressure
Education
- High school diploma or GED required
Mid-Level Healthcare Customer Care Representative
Position Overview
We are hiring a Mid-Level Healthcare Customer Care Representative with 2–5 years of experience in patient-facing support. In this role, you’ll independently handle a wide range of tasks including insurance verification, scheduling across multiple departments, and resolving billing inquiries. You’ll contribute to service quality by delivering timely, empathetic, and accurate assistance to every patient interaction.
Responsibilities
- Independently manage a high volume of inbound inquiries across multiple communication channels
- Perform insurance verification and interpret coverage limitations or authorizations
- Resolve billing questions and coordinate with revenue cycle departments
- Schedule complex appointments or procedures across multiple providers or departments
- Document interactions and resolutions in the EHR or CRM system
- Maintain compliance with HIPAA and internal privacy policies
- Act as a knowledge resource for newer staff when needed
Requirements
Hard skills
- Proficiency in EHR systems such as Epic or Cerner
- Strong understanding of insurance billing workflows
- CRM and call management software familiarity
- Ability to explain medical and billing terminology to non-medical individuals
Soft skills
- Independent problem-solving
- Compassionate, solution-focused communication
- Time management in a fast-paced setting
- Conflict resolution abilities
Education
- High school diploma or GED required
- Associate’s degree in healthcare or business preferred
Certifications
- Certified Healthcare Customer Service Representative (CHCSR) preferred
Senior Healthcare Customer Care Representative
Position Overview
We’re looking for a Senior Healthcare Customer Care Representative with 5+ years of experience to serve as a trusted resource for patients and team members. This advanced role involves handling escalated issues, mentoring junior staff, and contributing to continuous process improvement. The ideal candidate has deep knowledge of healthcare systems and an exceptional service mindset.
Responsibilities
- Manage high-complexity calls, including escalated patient concerns and multi-step billing disputes
- Assist with training and mentoring new team members
- Liaise with providers, billing, and compliance departments to resolve advanced issues
- Audit documentation to ensure data accuracy and policy compliance
- Track recurring patient issues and recommend system/process improvements
- Represent the team in cross-departmental initiatives or feedback sessions
Requirements
Hard skills
- Advanced proficiency in EHR and billing systems
- Strong understanding of insurance pre-authorizations, appeals, and denials
- Knowledge of CMS guidelines and payer policies
- Experience leading peer coaching or call quality reviews
Soft skills
- Leadership through influence and support
- Calm and professional communication during escalations
- High accountability and ownership of resolution outcomes
- Analytical mindset for identifying patterns and system gaps
Education
- High school diploma or GED required
- Associate’s or bachelor’s degree in healthcare administration preferred
Certifications
- Certified Medical Administrative Assistant (CMAA) or CHCSR strongly preferred
Healthcare Customer Care Team Lead
Position Overview
We’re hiring a Healthcare Customer Care Team Lead to oversee a team of customer care representatives and support day-to-day operations. This supervisory role combines staff mentorship, performance monitoring, and issue escalation support. You’ll help establish team goals, maintain high service standards, and implement workflow improvements.
Responsibilities
- Supervise a team of 8–15 representatives in a healthcare call center or virtual support environment
- Monitor daily productivity, quality assurance, and customer satisfaction metrics
- Provide coaching, feedback, and performance evaluations
- Handle escalated calls or issues beyond frontline staff scope
- Collaborate with department managers to enhance policies and training
- Schedule shifts, manage time-off requests, and support workforce planning
- Ensure consistent compliance with HIPAA and organizational standards
Requirements
Hard skills
- Experience using call center dashboards and reporting tools
- Proficiency with EHR, CRM, and ticketing systems
- Knowledge of call routing, KPIs, and agent workflow design
Soft skills
- Strong leadership and coaching abilities
- Conflict resolution across team and patient interactions
- Motivational communication and team building
- Time management and organizational strength
Education
- High school diploma or GED required
- Associate’s or bachelor’s degree preferred
Certifications
- Leadership development certifications or CHAM (Certified Healthcare Access Manager) are a plus
Remote Healthcare Customer Care Representative
Position Overview
We are seeking a tech-savvy and self-directed Remote Healthcare Customer Service Representative to support patients nationwide from a virtual setting. You’ll deliver the same high standard of service as onsite representatives while managing multiple digital communication platforms from a secure home environment. This role is best suited for those who thrive independently and are comfortable navigating cloud-based tools and healthcare data systems.
Responsibilities
- Respond to inbound calls, secure messages, or live chats from patients across the country
- Manage appointment scheduling, insurance verification, and basic triage remotely
- Ensure full HIPAA compliance in a home office environment
- Escalate urgent or complex issues through secure digital channels
- Maintain productivity benchmarks in a remote setting
- Communicate effectively and clearly through virtual channels
Requirements
Hard skills
- Strong familiarity with remote collaboration tools (Zoom, Teams, Slack)
- Experience with secure VPN access, dual-monitor setups, and encrypted communication
- Proficiency in EHR/CRM software used in remote healthcare operations
Soft skills
- High degree of self-motivation and accountability
- Written and verbal clarity across multiple platforms
- Adaptability to virtual workflows and changing technology
- Discretion and trustworthiness in handling PHI from home
Education
- High school diploma or GED required
Certifications
- HIPAA compliance training certification required
- Remote customer service or telehealth support certifications are a plus