Offer summary

Qualifications:

High School diploma or GED required; college courses preferred., One year of customer service and claims experience or equivalent education and experience is required., Knowledge of medical terminology and claims management is essential., Strong communication, organizational, and analytical skills are necessary. .

Key responsibilities:

Act as the primary liaison with callers, assisting with questions and solving problems related to claims.

Educate customers about documentation, time frames, payment information, and claim status through various communication channels.

Enter application information accurately into the claims management system and assign new claims to appropriate handlers.

Direct customer calls to the right contacts and escalate issues as needed, while supporting the organization's quality programs.

Job description

Job Description:

Pay Range: $13hr - $18hr

Responsibilities:

Acts as primary liaison with callers; follows client specifications in assisting with questions and solving problems related to the claims process and servicing processes.
Educates and informs the customer via multiple communication channels about documentation required to process a claim, required time frames, payment information, and claim status.
Educates members and providers on client requirements and benefit plans documenting all required details of the call in a concise professional manner.
Enters verbal and written application information that meets both the internal and external customer’s requirements accurately into the claims management system.
Assigns new claims to the appropriate claims handler.
Directs customer calls to the appropriate contact at multiple locations or escalates to Service Center Specialist/management as needed.
Attendance during scheduled work hours is required.
Performs other duties as assigned. Supports the organization's quality program(s).

Physical Demands (Due to nature of job):

The physical demands described here are representative of those that must be met by an employee to successfully perform the essential functions of this job.
Reasonable accommodations may be made to enable individuals with disabilities to perform essential functions.
While performing the duties of this job, the employee is regularly required to sit, talk, and hear.
The employee frequently is required to use the fingers to make small movements such as typing, picking up small objects, or pinching fingers together.
The employee is occasionally required to walk; reach with hands and arms; stoop, kneel, crouch, or crawl.
Sedentary work. Sitting most of the time.
Specific vision abilities required by this job include close vision, peripheral vision, depth perception, and the ability to adjust focus.
The employee moves within the facility in which their office is located to access file cabinets, documents, office machinery, and other equipment.
They also travel within their home office or facility in which their office is located and to locations outside of the facility, to attend meetings, training, events, and other business activities.
The candidate should be able to lift 10 pounds with assistance.
The employee holding this position must have strong communication and organizational skills, and an ability to interact and work with others.
They must be able to work under time constraints and deadlines.

Requirements:

Claims and Customer service is priority for experience.
This will be inbound calls to providers so understanding how offices operate would be beneficial but not essential.
Claims and Customer service is priority for experience.
Spanish speaking will be a plus, not mandatory.

Education:

High School diploma or GED required.
College courses preferred.

Experience:

One year of customer service and claims experience or an equivalent combination of education and experience is required.
Inbound call center experience preferred.

Other Skills and Abilities:

Qualifications Knowledge of medical terminology Understanding of claims management Excellent oral and written communication PC literate, including.
Microsoft Office products and must be comfortable on camera when requested.
Analytical and interpretive skills Strong organizational skills Good inter persona skills Ability to multitask in a fast-paced environment.
Ability to support multiple clients across communication channels and utilize multiple systems simultaneously.
Ability to work in a team environment and/or independently.
Ability to meet or exceed Performance Competencies.