Job Openings >> Customer Service Representative - Claims
Customer Service Representative - Claims
Summary
Title:Customer Service Representative - Claims
ID:1100
Department:Finance
Description

Job Summary: The Client Service Representative is responsible for interacting with medical offices, and health plans to provide and obtain information in response to inquiries regarding claim submissions, denials and other claims related requests.


Responsibilities

Answers incoming and places outbound phone calls from/to providers regarding status of claim requests and answers general questions.

Responsible for incoming and outgoing calls regarding claim denials or payments.

Manages the Claims Operations phone queue during business hours.

Meets designated timeframes to fulfill clients’ requests when communicating with Provider’s offices or Health Plans.

Provides effective customer service to our clients by appropriately responding to emails, phone calls and/or any communication regarding requested information.

Maintains consistent attendance to meet daily call center performance goals.

Research’s and assists team and management with claim projects, claims processing discrepancies, eligibility issues and claim rejections.

Supports Claims Operation team in claims processing activities.

Successful in meeting department production and quality standards and goals.

Acts with honor and integrity, serving as a representative for the company.

Respects and maintains HIPAA confidentiality guidelines.

Assist with other responsibilities or duties as needed.

 

Educational & Experience Requirements

  • Associate's degree in a related field or equivalent relevant work experience.
  • Knowledge of medical terminology, health insurance plans, medical billing concepts.
  • Minimum 2 years of experience in a managed care and claims.
  • Previous experience in Call Center production environment preferred.
  • Previous experience in production environment required.

Language Skills

  • Ability to read and communicate effectively in English.
  • Additional languages preferred.

Skills

  • Proficient computer knowledge such as Word and Excel.
  • Excellent communication skills and telephone etiquette.
  • Ability to work accurately and efficiently.
  • Ability to interact effectively and in a supportive fashion with persons of all backgrounds.
  • Data entry and basic calculations.
  • Self-starter with ability to work independently.
  • Ability to sit for extended periods and read monitors.
  • Strong attention to detail.

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