Customer Service Representative

Provide excellent customer service primarily by telephone to all customers. Assist customers with coverage/claims related questions. Accurately interpret benefits and policy provisions for all products. Conduct appropriate research and follow-up for prompt resolution of disputed claims. Temp to hire opportunity!

• Work efficiently in a high volume call center while maintaining a professional, positive, and caring demeanor.
• Assist callers with coverage related questions/concerns; accurately interpret policy provisions for assigned products.
• Analyze customer’s inquiries and determine correct steps for resolution, interpret benefit information, and claims processing accuracy.
• Keep resource information up to date and well organized.
• Work efficiently in multiple systems simultaneously while effectively utilizing critical thinking and problem solving skills.
• Document calls in a clear and consistent manner in computer system.
• Conduct appropriate research, take ownership and follow through for prompt resolution of disputed claims.
• Relay information to appropriate departments and personnel using established communication channels and procedures.
• Make outbound calls to members as necessary dependent upon current outreach campaign.

• Meet department and company performance and attendance expectations.
• Be aligned with company values.
• Follow the privacy policy and HIPAA laws and regulations concerning confidentiality and security of protected health information.
• Perform other duties as assigned.

• Work Experience:
  
  One-year medical insurance, other healthcare related field, call center or customer service experience required.
• CPT/ICD-10 coding preferred.
• Education, Certificates, Licenses:
  High School Diploma or equivalent required.
• Knowledge:
  Basic understanding of insurance and medical terminology, coding and standard medical billing practices preferred.
• Proficient computer skills, typing, and 10-key required.
• Strong written and verbal communication skills.