Demo

Claims/Customer Service Representative

The Health Plan of West Virginia Inc
Charleston, WV Full Time
POSTED ON 3/3/2025
AVAILABLE BEFORE 4/27/2025

The Stop Loss Rep works with Reinsurance Carriers in filing for reimbursement for groups that have claimants that have gone over the Specific Stop Loss deductible.

Requirements:

  1. High School graduate or equivalent.
  2. Motivated and works independently.
  3. Detail oriented with good problem solving skills.
  4. Ability to prioritize and meet deadlines.
  5. Proficient in basic math skills.
  6. Proficient in Microsoft Office products.
  7. Adaptable to changes.

Desired:

  1. Two (2) years of insurance experience in a claims processing and/or call center environment.
  2. Familiar with insurance terminology.
  3. Knowledge of stop loss/reinsurance.

Responsibilities:

  1. Maintain a positive working relationship with others.
  2. Communicate with internal and external customers in a timely, professional and friendly manner.
  3. Determine claims potentially eligible for filing.
  4. Demonstrate the proper sense of urgency needed for obtaining all information for filing or preparing to file stop loss claims.
  5. Communicates with Account Executives to obtain information from the Client required by the stop loss carrier.
  6. Files stop loss claims in an accurate, complete and timely manner.
  7. Run and/or proved stop loss reporting accurately and timely including both internally and externally.
  8. Works with stop loss carriers, Account Executives, Claims Team, Financial and Eligibility Departments to resolve issues at the root cause.
  9. Records and communicates all information clearly and accurately.
  10. Keep all member's protected health information (PHI) confidential.

If your compensation planning software is too rigid to deploy winning incentive strategies, it’s time to find an adaptable solution. Compensation Planning
Enhance your organization's compensation strategy with salary data sets that HR and team managers can use to pay your staff right. Surveys & Data Sets

What is the career path for a Claims/Customer Service Representative?

Sign up to receive alerts about other jobs on the Claims/Customer Service Representative career path by checking the boxes next to the positions that interest you.
Income Estimation: 
$35,979 - $45,091
Income Estimation: 
$41,527 - $53,091
Income Estimation: 
$49,126 - $60,591
Income Estimation: 
$70,647 - $86,374
Income Estimation: 
$123,613 - $165,638
Income Estimation: 
$69,116 - $84,792
Income Estimation: 
$87,788 - $104,837
Income Estimation: 
$70,647 - $86,374
Income Estimation: 
$123,613 - $165,638
Income Estimation: 
$69,116 - $84,792
Income Estimation: 
$44,557 - $53,909
Income Estimation: 
$55,490 - $70,607
Income Estimation: 
$49,313 - $64,855
Income Estimation: 
$49,126 - $60,591
Income Estimation: 
$38,612 - $46,691
Income Estimation: 
$48,731 - $60,363
Income Estimation: 
$43,963 - $55,591
Income Estimation: 
$44,557 - $53,909
View Core, Job Family, and Industry Job Skills and Competency Data for more than 15,000 Job Titles Skills Library

Job openings at The Health Plan of West Virginia Inc

The Health Plan of West Virginia Inc
Hired Organization Address Wheeling, WV Full Time
The Case Management/Disease Management Nurse Navigator is responsible for assessing moderate to high risk patients for c...
The Health Plan of West Virginia Inc
Hired Organization Address Wheeling, WV Full Time
The Pharmacy Technician is responsible for answering member, pharmacy, and provider questions as well as researching and...
The Health Plan of West Virginia Inc
Hired Organization Address Charleston, WV Full Time
The Stop Loss Rep works with Reinsurance Carriers in filing for reimbursement for groups that have claimants that have g...
The Health Plan of West Virginia Inc
Hired Organization Address Wheeling, WV Part Time
Job Description Job Description The mail / facilities clerk is responsible for processing all incoming and outgoing mail...

Not the job you're looking for? Here are some other Claims/Customer Service Representative jobs in the Charleston, WV area that may be a better fit.

Claims / Customer Service Representative

The Health Plan of West Virginia, Inc., Charleston, WV

Customer Service Representative

Lensa, Charleston, WV

AI Assistant is available now!

Feel free to start your new journey!