SGS-Service Center Representative

Duties:
Positions are all part time
Pre-screening questions must be on resume with any testing/training results performed prior to submittal

Job Summary
The Service Center Representative processes medical claims and communicates with providers about the claims process. The position is responsible for daily claims management and is recognized as a general technical expert in the health benefits program. The Service Center Representative 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.

Job Description
Essential Functions Duties and Responsibilities
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 customers 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).

Physical Demands
The physical demands described here are representative of those that must be met by an employee to successfully perform the essential functions of this job. Reasonable accommodations may be made to enable individuals with disabilities to perform essential functions. While performing the duties of this job, the employee is regularly required to sit, talk, and hear. The employee frequently is required to use the fingers to make small movements such as typing, picking up small objects, or pinching fingers together.

The employee is occasionally required to walk; reach with hands and arms; stoop, kneel, crouch, or crawl. Sedentary work. Sitting most of the time. Specific vision abilities required by this job include close vision, peripheral vision, depth perception, and the ability to adjust focus. 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. Job Specifications

Skills:
Pre-screening questions must be on resume with any testing/training results performed prior to submittal
This position is a Call center experience with preferably Claims and Customer service, please advise experience with both:
Are you able to answer and make calls as required
How do you handle high call volumes while maintaining quality service
Please describe your proficiency with MS Suite and writing emails
Do you meet the SGS Minimum IT Requirement to work from home
Are you capable of setting up computer equipment with instructions
Do you have any issues being on camera during training and team meetings
What makes you a strong fit for this call center role

Confirm all Candidates Must be Able to Work a Set Part Time Shift:
Work Days:
Tuesday - Thursday
Schedule 9a - 4p EST

Manager Notes:

We need candidates who fully understand that we expect complete engagement in trainings, start times have to be adhered to and we need proactive communication when something uncontrollable comes up. We also continue to experience a gap between representations made on a resume and in the interview with the resources actual competency once training begins. We realize that our "environment" is unique - our systems aren't to the point where you "push a button" and get an answer - we need someone who is comfortable with research skills (in different systems), who is patient doing this with a customer on the phone, and show critical thinking aptitude.
Claims and Customer service is priority for experience, must be US Citizen
Location - Remote, SGS Minimum IT Requirement = Supplier partners MUST confirm that candidates meet the work from home IT Requirements. BG check package - sterling managed care advisors package
Suppliers must review the attached Remote Work Policy and the Minimum IT Requirements…