What are the responsibilities and job description for the Insurance Customer Service Specialist position at Forest County Potawatomi Insurance Department?
Here’s what you’ll be doing:
- Resolves customer service issues, expedites the adjustments and follow ups to ensure the resolution; adjudicates required claim adjustments identified through communication with members, employees and clients
- Updates and maintains information and knowledge regarding plans and benefits administered by the Insurance Department; educates members and external customers on policies and procedures related to members’ health care program
- Interprets member eligibility and coverage through knowledge benefit plans, Contract Heath Service programs, claims and departmental procedures needed to assist Tribal members, employees and other clients; initiates check tracers and investigate claim payment irregularities
- Collaborates with the FCPHWC, ICW, Child Support, Economic Support, Elderly, and other FCP Departments to assist in providing Tribal members information needed to ease access to care; assists in the development and communication of resolutions, procedures and policies to internal staff, as requested
- Performs the role as Health Care Coordinator for the Potawatomi Cares Plus program; identifies trends/issues that emerges in calls/correspondence, and informs Supervisor or Director
What you’ll need to be successful:
- High school diploma or GED
- Knowledge of medical terminology, insurance, and billing; NCCI and CMS coding standards
- Knowledge of applicable federal, state, county, and local laws, regulations, and requirements
- Knowledge of all FCPC benefit plans, health programs, eligibility, claims, and departmental procedures needed to assist employees and tribal members
- Must successfully pass all applicable background checks and drug screens
Preferred Qualifications:
- Two (2) year degree in health related or communication field, including a course in medical terminology preferred
- Three (3) years call center customer service experience in a health insurance, physician group practice or hospital setting preferred
Benefits you’ll love:
- Approximately 5 weeks of paid time off annually
- 3 weeks of paid holidays
- Premium free health insurance
- Flexible spending accounts
- Short term disability
- Life insurance
- 401k with match