Customer Service Representative - Claims​/Health Plan; Pennsylvania resident

Location

Work from home (Pennsylvania)

Days (United States of America)

40

Regular

No

Assists in resolving customer concerns, providing appropriate education/instruction and maintaining customer satisfaction by providing the highest level of customer service. Actively participates in cross training, improving processes within the Customer Service team.

• Resolve and reconcile enrollment reports and all related eligibility issues by following policy and procedure as well as any state legislated coverage and eligibility guidelines.
• Initiate communication and literature to the newly enrolled Health Plan member, dependents and employer groups.
• Interpret and appropriately apply rules and regulations in contractual agreements and with employer groups and vendors.
• Perform membership data extract reports and supply them to employer groups as an audit tool for accuracy and compliance with performance risk guarantee commitments.
• Update, approve and interpret membership data and workflow produced by online software capabilities in employer group modules.
• Determine the eligibility of most members as well as process terminations and disenrollments.
• Prepare, generate and appropriately disseminate letter communications to subscribers and members with regard to enrollment activity.
• Determine if services received are covered benefits as applicable by line of business and product design.
• Review suspended claims for resolution by applying current policies, procedures and benefits applicable to specific products.
• Provide team building resources to assist in directing peers to proper claims resolution policies and procedures in order to assist members and providers.
• Provide daily support and advice to member and provider services staff regarding claims issues.
• Research claim issues from participating providers and identify specific criteria for reconsideration for payment.

Work is typically performed in an office environment. Accountable for satisfying all job‑specific obligations and complying with all organization policies and procedures. The specific statements in this profile are not intended to be all‑inclusive. They represent typical elements considered necessary to successfully perform the job.

• Education
  :
  High School Diploma or Equivalent (GED) – Required
• Experience
  :
  Minimum of 1 year – Customer Service (Required)
• Certification(s) and License(s):
  None specified
• Skills
  :
  Communication, Customer Retentions, Customer Service

• KINDNESS
  :
  We strive to treat everyone as we would hope to be treated ourselves.
• EXCELLENCE
  :
  We treasure colleagues who humbly strive for excellence.
• LEARNING
  :
  We share our knowledge with the best and brightest to better prepare the caregivers for tomorrow.
• INNOVATION
  :
  We constantly seek new and better ways to care for our patients, our members, our community, and the nation.
• SAFETY
  :
  We provide a safe environment for our patients and members and the Geisinger family.

We offer healthcare benefits for full time and part time positions from day one, including vision, dental and domestic partners. Perhaps just as important, we encourage an atmosphere of collaboration, cooperation and collegiality.

We know that a diverse workforce with unique experiences and backgrounds makes our team stronger. Our patients, members and community come from a wide variety of backgrounds, and it takes a diverse workforce to make better health easier for all. We are proud to be an affirmative action, equal opportunity employer and all qualified applicants will receive consideration for employment regardless to race, color, religion, sex, sexual orientation, gender identity, national origin, disability or status as a protected veteran.