Claims Customer Service

Overall Purpose:

We are looking for a skilled problem solver to join our team as a Claims Customer Service Representative. We need an enthusiastic individual who can interact with providers by listening to their issues/concerns and offer quick and accurate assistance. The candidate for this role will have a strong command of claims policies and be well-trained in providing excellent customer service. Interacting with providers over the phone and via email, answering incoming calls, emails, and returning voicemails regarding claims payment/denial issues, questions, and any other concerns, while maintaining a high level of professionalism.

Education and Experience:

• High school diploma/GED required
• 1 year Customer Service experience
• 1 year Call Center experience
• 1 year Claims processing experience

Knowledge, Skills and Abilities:

• Strong verbal and written communication skills with the ability to work with diverse personalities
• Enthusiastic and bold attitude with great customer service skills
• A problem solver with strong attention to detail
• Ability to address customer concerns creatively and share feedback with other teammates
• Works as a team member, as well as independently, with minimal supervision
• Demonstrate a strong customer service orientation and takes responsibility to ensure customer satisfaction
• Must have a strong understanding of any local, state and federal rules regarding claims
• Working knowledge of HMO operations, Claims, and Customer Service
• Must have a strong knowledge of CPT, ICD-10 and CMS Guidelines
• Ability to multi-task and adapt to changes quickly
• Strong analytical and multi-tasking skills
• Strong organizational and time management skills with the ability to prioritize and maintain several phone queues/return voicemails/and answer emails in a timely manner.
• Personal computer with main frame emulation, claims management software, word processing and management software, 10-key adding machine, Imaging retrieval software, fax machine, copy machine, basic office aids

Essential Functions:

• Engage with providers in a friendly and professional manner while actively listening to their concerns
• Answers incoming provider calls regarding claims status, payment issues, denials, general questions and concerns
• Responsible for maintaining a high level of professionalism with providers and working to establish a positive rapport with every caller
• Create a customer service incident in the customer service database during and after each call for tracking and reporting purposes
• Work with the management team to stay updated on claims processing guidelines and be informed of any changes in company policies
• Problem solving and ability to remain professional and courteous with customers at all times
• Performs other duties and responsibilities as directed, assigned or requested

Equal Opportunity Employer/Protected Veterans/Individuals with Disabilities

The contractor will not discharge or in any other manner discriminate against employees or applicants because they have inquired about, discussed, or disclosed their own pay or the pay of another employee or applicant. However, employees who have access to the compensation information of other employees or applicants as a part of their essential job functions cannot disclose the pay of other employees or applicants to individuals who do not otherwise have access to compensation information, unless the disclosure is (a) in response to a formal complaint or charge, (b) in furtherance of an investigation, proceeding, hearing, or action, including an investigation conducted by the employer, or (c) consistent with the contractor’s legal duty to furnish information. 41 CFR 60-1.35(c)