Offer summary

Qualifications:

High School Diploma or GED required, with verification., 2+ years of experience in healthcare, call center, or customer service settings., Knowledge of Medical Terminology, ICD-9/ICD-10, and CPT codes is essential., Proficiency in Microsoft Office applications, particularly Word, Excel, and Outlook..

Key responsibilities:

Manage authorizations and service requests via phone calls, faxes, and portal submissions.

Provide excellent customer service and handle escalated calls effectively.

Prepare authorization cases for Medical Directors and Case Managers.

Confirm member eligibility and maintain knowledge of health plan benefits and regulations.

Job description

Job Description:

Job Tittle: Claim Representative
Job Location: 100% Remote
Job Type: Full-time

Primary Responsibilities:

Managing authorizations / notifications and other service requests received via incoming phone calls, faxes and portal submission
Providing excellent customer service, including the ability to handle escalated callers
Determining authorization or notification requirements
Preparing authorization cases for Medical Directors, Network Operations Nurses and Case Managers
Providing administrative approvals (depends on line of business)
Handling expedited authorizations, authorization updates and status checks
Confirming member eligibility
Outreaches to providers and/or Patient to complete authorization requests and prescriptions
Maintaining knowledge of various health plan partner benefits, networks, CMS regulations and health plan partner policies
Utilizing experience and judgement to plan, accomplish goals and effectively resolve each assigned task
Non-Clinical staff is not responsible for conducting any Network Operations activity that requires interpretation of clinical information.
Performs all other related duties as assigned.
You’ll be rewarded and recognized for your performance in an environment that will challenge you and give you clear directions on what it takes to succeed in your role as well as provide development for other roles you may be interested in.

Required experience:

Medical Terminology
ICD 9/ICD 10 and CPT knowledge
Claim Experience
Call center experience
Highschool Diploma minimum is required and will be verified
1.5 to 2 years of claims experience

Qualifications:

High School Diploma / GED (or higher) (This will be verified through $Diverse Lynx$)
2+ years of combined or related experience in a healthcare, call center, and/or customer service setting using the telephone and computer as the primary instrument to perform job duties
Ability to work one of the varying shifts to support our 24hr 7 days a week operation
Proficiency with Microsoft Office Word (create and maintain documents), Excel (create and maintain spreadsheets) and Outlook (email and calendaring) Medical Terminology
ICD-9/ICD-10 and CPT Knowledge
Required to have a dedicated work area established that is HIPPA compliant.
Ability to keep all company sensitive documents secure (if applicable)
Must live in a location that can receive approved high-speed internet connection or leverage an existing high-speed internet service

Diverse Lynx LLC is an Equal Employment Opportunity employer. All qualified applicants will receive due consideration for employment without any discrimination. All applicants will be evaluated solely on the basis of their ability, competence and their proven capability to perform the functions outlined in the corresponding role. We promote and support a diverse workforce across all levels in the company.

Required profile