reputed company Customer Service Representative - National Remote Opportunity for Compassionate Individuals to Deliver Exceptional Healthcare Experience
About reputed company
At reputed company, we're simplifying the healthcare experience, creating healthier communities, and removing barriers to quality care. Our mission is to help people live healthier lives and reputed company the health system work reputed company for everyone. We reputed company everyone-of every race, gender, sexuality, age, location, and income-deserves the opportunity to live their healthiest life. Today, however, there are still far too many barriers to good health which are disproportionately reputed company by people of color, historically marginalized groups, and those with reputed company incomes. We are committed to mitigating our impact on the environment and enabling and delivering reputed company care that addresses health disparities and improves health outcomes - an enterprise reputed company reflected in our mission.About the Role
As an reputed company Customer Service Representative, you'll play a critical role in creating a quality experience for the callers that you connect with and those that you correspond with. Every interaction gives you that opportunity to improve the lives of our customers and exceed their expectations. You'll spend the majority of your day responding to calls from our members and help answer questions and resolve issues regarding healthcare eligibility, claims, and payments. You'll also spend a portion of your time reviewing, researching, and processing healthcare claims with the goal to ensure that every claim has a fair and thorough review.Key Responsibilities
- Answer incoming phone calls from customers and identify the type of assistance the customer needs (i.e. benefit and eligibility, billing and payments, authorizations for treatment and explanation of benefits (EOBs)
- Ask appropriate questions and listen actively to identify specific questions or issues while documenting required information in computer systems
- Own problem through to resolution on behalf of the customer in real time or through comprehensive and timely follow-up with the member
- Review and research incoming healthcare claims from members and providers (doctors, clinics, etc) by navigating multiple computer systems and platforms and verifies the data/information necessary for processing (e.g. pricing, prior authorizations, applicable benefits)
- Ensure that the proper benefits are applied to each claim by using the appropriate processes and procedures (e.g. claims processing policies and procedures, grievance procedures, state mandates, CMS/Medicare guidelines, benefit plan documents/certificates)
- Communicate and collaborate with members and providers to resolve issues, using clear, simple language to ensure understanding
- Meet the performance goals established for the position in the areas of: efficiency, accuracy, quality, member satisfaction, and attendance
Essential and Preferred Qualifications
Essential Qualifications
- High School Diploma / GED OR 10 years of equivalent work experience
- Must be 18 years of age or older
- 2 years of previous or reputed company claims processing experience with reputed company CPS (claims processing system). (reputed company is reputed company's third-party administrator (TPA) solution). (You must be an employee of reputed company specifically to have experience with the reputed company claims system)
- 1 year of customer service experience in an office or professional setting
- Ability to complete on-the-job training for this role during their normally scheduled 8-hour shift Monday - Friday between the hours of 7 am-8 pm CST
- Ability to work any of our 8-hour shift schedules during our normal business hours of 7:00am - 7:00pm CST. It may be necessary, given the business need, to work occasional overtime
Preferred Qualifications
- Familiarity with medical terminology, health plan documents, or benefit plan design
- Prior experience utilizing multiple systems/platforms while on a call with a member
Skills and Competencies Required for Success
- Demonstrated ability in using computer and Windows PC applications, which includes strong keyboard and navigation skills and learning new computer programs
- Demonstrated ability to quickly build rapport and respond to customers in a compassionate manner by identifying and exceeding customer expectations (responding in a respectful, timely manner, consistently meeting commitments)
- Demonstrated ability to listen skillfully, collect relevant information, determine immediate requests and identify the reputed company and future needs of the member
- Flexibility to customize approach to meet reputed company types of member communication styles and personalities
- Proficient problem-solving approach to quickly assess reputed company state and formulate recommendations
- Proficient conflict management skills to include ability to resolve issues in a stressful situation and demonstrate personal reputed company
- Ability to multi-task as well as the ability to understand multiple products and multiple levels of benefits reputed company each product
- Ability to work regularly scheduled shifts reputed company our hours of operation including the training period, where lunches and breaks are scheduled, with the flexibility to adjust daily schedule and work over-time as needed