What are the responsibilities and job description for the Service Center Representative position at Synectics Inc?
Description:
The Service Center Representative processes medical claims and communicates with providers about the claims process.
Responsible for daily claims management and is recognized as a general technical expert in the health benefits program.
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.
Attendance during scheduled work hours is required.
Performs other duties as assigned.
Supports the organization's quality program(s).
The employee moves within the facility in which their office is located to access file cabinets, documents, office machinery, and other equipment. They also travel within their home office or facility in which their office is located and to locations outside of the facility, to attend meetings, training, events, and other business activities.
An employee in this position may lift, carry, push, and/or pull objects weighing up to 10 lbs. Occasionally may move objects weighing up to 10-20 lbs. The employee holding this position must have strong communication and organizational skills, and an ability to interact and work with others.
They must be able to work under time constraints and deadlines.
Requirements:
High School diploma or GED required.
College courses preferred.
Claims and Customer service is priority for experience
Spanish speaking will be a plus, not mandatory
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.
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
This will be inbound calls to providers so understanding how offices operate would be beneficial
Benefits:
Healthcare Insurance: Synectics offers eligible employees and their dependents healthcare coverage through BlueCross BlueShield of Illinois. Eligibility begins on the 1st day of the calendar month following 60 days of continuous full time employment with Synectics. Premiums are subsidized by Synectics.
Dental Insurance: Synectics offers eligible employees and their dependents a dental plan through MetLife. Eligibility begins on the 1st day of the calendar month following 60 days of continuous full time employment with Synectics.
Vision Insurance: Synectics offers eligible employees vision insurance through VSP. Eligibility begins on the 1st day of the calendar month following 60 days of continuous full time employment with Synectics.401(k) Plan: The Synectics Inc. Investment Savings Retirement Plan. Synectics offers all employees who are 21 years of age or older the opportunity to invest in the 401(k) Plan on the first enrollment date that is at least 30 days after employment begins. Enrollment dates are each January 1st, April 1st, July 1st, and October 1st.
Technical Certification Bonus: Synectics is pleased to award its employees a bonus of up to $500 for an approved professional certification. In determining the bonus amount, Synectics will consider the cost of the test(s) for any certification relating to your current position, achieved during your employment with us. Only one Certification Bonus per calendar year may be awarded per employee. Only current, active employees will be eligible to receive this bonus. It will be awarded 90 days after the Synectics office has received documentation confirming the successful completion of the certification.
Synectics is an equal opportunity employer.
