CSR II Adjudication

JOB TITLE:                          CSR II Adjudication ($16/hr + $1/pay for performance, work from home)

DEPARTMENT:                  Operations          

REPORTS TO:                     Supervisor     

FLSA STATUS:                    Non-Exempt                                                     

OUR GUIDING PRINCIPLES:  

Make every interaction Count 

Act with Respect and Integrity 

Demonstrate Passion for Continuous Improvement 

Be Worth of Trust from all Stakeholders 

OVERVIEW:

The Customer Service Representative II (Adjudication) ensures compliance with client's program specifications and SaviLinx policies and procedures. This position is responsible for the accurate review, input, and adjudication of claims. 

ESSENTIAL FUNCTIONS:

• Demonstrates ability to work in accordance with the Savilinx Guiding Principles. 
• Supports the day-to-day processing of claims for a contract with the following duties. 
• Acknowledges establishment of new claims assigned daily. 
• Accepts telephone calls from claimants. 
• Adjudicates claims within guidelines ensuring the benefit eligibility is correctly determined. 
• Researches and resolves escalated and complex claim issues in a timely manner. 
• Reviews supporting documentation for accuracy. 
• Connects with applicants to guide them through the claim process. 
• Maintains and follows-up on pending files, as required by guidelines.  
• Practices all policies and procedures to PHI and HIPAA. 
• Documents all claimant information, communications in CRM system. 
• Ensures privacy, confidentiality, and precision with all work. 
• Maintains a working knowledge of our clients’ requirements. 
• Regular and consistent attendance is an essential function of the job. 

SUPERVISORY RESPONSIBILITY:

No Supervisory responsibility.

EXPECTED WORKDAYS/ HOURS:

This position requires work Monday-Friday 8am-5pm.

LOCATION: 

Work from Home based on performance and internet connectivity.

QUALIFICATIONS:  

• 2+ years of contact center experience preferred.
• High school diploma or equivalent required.   
• Time management skills and the ability to work independently are essential for this role. 
• Must have experience with maneuvering electronic data between various environments. 
• Analytical thinking, communication and writing skills, and computer competencies. 
• Prior experience with PHI or HIPAA preferred
• 2+ years of college preferred.

OTHER DUTIES: 

Please note, this job description is not designed to cover or contain a comprehensive listing of activities, duties or responsibilities that are required of the employee for this job. Duties, responsibilities, and activities may change at any time, with or without notice.

EQUAL EMPLOYMENT OPPORTUNITY: 

SaviLinx, LLC provides equal employment opportunities to all employees and applicants for employment and prohibits discrimination and harassment of any type without regard to race, color, religion, age, sex, national origin, disability status, genetics, protected veteran status, sexual orientation, gender identity or expression, or any other characteristic protected by federal, state or local laws.  
 

VEVRAA FEDERAL CONTRACTOR/EQUAL OPPORTUNITY EMPLOYER