Company Summary:

S&S Health
is a Third-Party Administrator specializing in a full-service health care delivery system.

Position Summary:

The Call Center Representative provides expert service to providers, members and clients who have claims, eligibility and benefit related questions by promptly responding to their concerns in a timely manner. In addition, this position resolves payment/adjudication questions at the time the call is received; explaining calculation methodology,
contract terms procedures, etc. for the designated call center within S&S Health. Some shift flexibility and mid-shift opportunities are available!

Essential Functions:

• Help providers and members navigate the complex healthcare ecosystem

• Field member and provider inquiries by phone and email

• Customer service focus with a keen understanding of the importance of average speed of answer, average handle times, abandonment rates, and first call resolution

• Answer customer service lines promptly and professionally and maintain at least a 95% response time.

• Collaborate with teammates to investigate and resolve complex calls

• Provide feedback to improve the Company

• Clearly communicates claims status, payment methodology, contract terms, procedures, etc. to providers, members and clients.

• Informs and assists callers with the claim’s appeals process, where appropriate.

• Demonstrates excellent customer service by determine the reason for the call, acknowledging the callers concerns and resolve concerns and/or explain action to be taken within the expected time line for resolution.

• Performs research on complex claim inquires and expertly re-examines claims in order to drive first call resolution

• Presents a pleasant voice to all callers, regardless of the stressful nature of the situation.

• All other duties as assigned.

Minimum Qualifications:

• Call Center experience necessary; healthcare call center experience preferred.

• Demonstrated knowledge of health claims, coding and processing guidelines.

• Maintain a knowledge of plan designs, PPO, indemnity plans, and all other contracts and services provided by S&S Health.

• Medical terminology and insurance related experience a plus.

• Strong interpersonal skills to interact with customers, management and peers.

• Very organized and detail-oriented.

• High level of self-motivation, productivity and attention to detail; be well-organized; have excellent verbal and written

• Excellent analytical, problem-solving, multi-tasking, verbal and written communication skills

• Flexibility to work evening hours based upon business need

• Excellent attendance required