High school diploma or GED required; college courses preferred.
At least one year of customer service and claims experience or an equivalent combination of education and experience; inbound call center experience preferred.
Knowledge of medical terminology and understanding of claims management; PC literate (Microsoft Office) and comfortable on camera when requested.
Strong communication, analytical, and multitasking skills; ability to work in a fast-paced environment and to support multiple clients across communication channels.
Requirements:
Process medical claims and manage daily claims activities; communicate with providers about the claims process and escalate issues as needed.
Enter verbal and written application information into the claims management system accurately; assign new claims to the appropriate claims handler and maintain detailed claim notes.
Educate customers (members and providers) on documentation requirements, timeframes, payment information, claim status, and client requirements while documenting call details professionally.
Direct calls to the appropriate contacts across multiple locations or escalate to Service Center Specialist/management; support the organization's quality program(s).
Job description
Our Client, a Business Solutions company, is looking for a Service Center Representative for their Remote location.
Responsibilities:
The Service Center Representative processes medical claims and communicates with providers about the claims process. The position is responsible for daily claims management and is recognized as a general technical expert in the health benefits program. The Service Center Representative expedites the claims process and provides detailed claim notes on all calls; as well as resolves issues and directs calls to an appropriate escalation path as needed.
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. Performs other duties as assigned. Supports the organization's quality program(s).
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
High School diploma or GED required.
College courses preferred.
One (1) year of customer service and claims experience or an equivalent combination of education and experience is required.
Inbound call center experience preferred.
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 interpersonal 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
ICONMA is an Equal Opportunity Employer. All qualified applicants will receive considerationfor employment without regard to any status protected by applicable law.
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