Claims Representative

STRATEGIC STAFFING SOLUTIONS HAS AN OPENING!

This is a Contract Opportunity with our company that MUST be worked on a W2 Only. No C2C eligibility for this position.

Job Title: Benefits & Claims Representative
Location: Baton Rouge, LA 70809
Work Schedule: Remote - 100% onsite for training; may be required onsite several times per month
Contract Length: 6 Months

Job  # 247880

• 1+ year of customer service or medical office experience
• OR completion of BRCC Medical Assistant, Coding & Insurance pathway in lieu of experience

• High School Diploma or equivalent

• Strong verbal and written communication skills with professionalism and empathy
• Ability to interpret and explain benefits, claims, and policies clearly
• Critical thinking and problem-solving skills
• Ability to multitask and manage multiple inquiries in a fast-paced environment
• Attention to detail and organizational skills
• Conflict resolution and ability to remain calm under pressure
• Active listening and effective questioning skills
• Proficiency in Microsoft Office and related systems
• Must live within 45 miles of Baton Rouge, LA
• Must have broadband internet service at home
• AT&T Air and T-Mobile 5G internet are not compatible with required equipment
• Must successfully complete customer service training and demonstrate proficiency

• Call center experience
• Familiarity with healthcare/insurance terminology

• Resolve benefit and claims inquiries from members and providers via telephone and other approved channels
• Handle inbound inquiries related to benefits, claims, billing, and eligibility
• Research and resolve customer issues across multiple systems to ensure accuracy of benefits and payments
• Respond to inquiries regarding adjustments, refunds, and payment discrepancies
• Maintain up-to-date knowledge of policies, procedures, and regulatory requirements
• Document interactions and ensure completeness and accuracy of information
• Meet established customer service performance metrics, including quality, productivity, customer satisfaction, and attendance
• Demonstrate ownership of issues and drive First Call Resolution (FCR)
• Work in a high-volume call center environment, with approximately 95% of time spent on the phone
• May be required to work during emergencies or inclement weather
• Perform other duties as assigned within scope