Customer Service Representative Job Northern Kentucky USA,Healthcare

Position: Customer Service Representative I
Location: Northern

PEHP Health & Benefits is a division of the Utah Retirement Systems that proudly serves Utah’s public employees through high quality and competitively priced medical, dental, life, and long-term disability insurance plans on a self-funded basis. As a government entity, we embrace both a public mission and a commitment to creating customer value, excelling in the market, and improving healthcare. We offer a competitive salary with generous benefits, personal development in a positive team environment, and excellent work-life balance.

For most jobs, remote work is available for 9 out of every 10 workdays.

POSITION SUMMARY

Plays a critical role in PEHP’s efforts to serve and create value for our members and providers by helping them understand benefits, avoid payment surprises, navigate healthcare complexity, resolve problems, and make good benefit decisions.

Performs a variety of duties to handle incoming calls, faxes and emails regarding claims, eligibility, verification of benefits, limitations, exclusions, provider applications and contracts, Health Savings Accounts (HSA), Health Reimbursement Accounts (HRA), FLEX Spending Accounts, Healthy Utah and Wee Care programs, billings and payments, and website related questions, for all PEHP plans.

Successful performance for the position requires a genuine interest in helping others, the ability to learn about and share complex information about health benefits, and a high level of commitment and dependability.

ESSENTIAL DUTIES & RESPONSIBILITIES

Receives and responds to incoming phone calls from policy holders, claimants, providers, and representatives of other insurance companies. Quotes benefits and provides claim status. Responds to complex questions regarding eligibility for covered services, claims processing policy descriptions and interpretations, claim payment processes, appeals and prior authorization/pre-notification, coordination of benefits, enrollment eligibility, and billing and premium questions.

Greets the public and meets with policyholders/claimants regarding medical and dental issues related to benefits, claims, and payment status. Responds to questions regarding claims process, policy descriptions and interpretations, payment process, eligible or covered service, billing and premium questions, and various other insurance related questions.

Educates members and providers on website tools and navigation and assists with online changes and updates. Troubleshoots account issues including setup, password resets, along with other various website issues.

Identifies erroneous claims adjudication, member enrollment, provider set up, prior authorization/pre-notification in a timely manner, including the processing of any research and correction requests.

Makes outgoing phone calls to assist members and providers in submitting information necessary to assist in benefit utilization, claim processing, completion of preauthorization requests, and appeals.

Provides walk-in clients with requested forms, publications, and other informational materials. Directs walk-in clients and visitors to proper office locations; apprises staff of appointment arrivals. Listens to client complaints, questions, etc., and mails any forms that are requested.

Provides clerical/secretarial support to various departments with the collection of forms, premium payments, etc., advises members of premium obligation, verification forms, etc., and returns incomplete forms.

Interprets PEHP policies for walk-in clients regarding pharmacy and medical medications to determine coverage for retail, mail-order, and specialty medications. Serves as a resource to help resolve pharmacy issues pertaining to pre-authorizations, appeals, eligibility, mail-order issues, benefit…