Health Customer Service Representative

POSITION RESPONSIBILITIES :

Through a respectful, constructive, and energetic style guided by the objectives of the Company the Customer Service Representative answers telephone inquiries from plan participants, client contacts, and providers regarding self-funded and partially self-funded group health benefits and / or the fully insured product. The incumbent is also responsible for claims payment research. The Customer Service Representative responsibilities to the team members and team lead increase by assisting as requested to help the team succeed.

The incumbent is expected to communicate professionally with peers, supervisors, subordinates, vendors, customers, and the public, and to be respectful and courteous in the conduct of this position.

ESSENTIAL JOB FUNCTIONS :

Essential job functions include the following. Other functions may be assigned as business conditions change.

• Answer telephone calls from plan participants, group contacts, and providers pertaining to benefits and claims inquiries.
• Provide clear and accurate responses to requests for information.
• Document all calls into Chronolog (by typing in highlights of the conversation) for future referral.
• Return messages left in designated voice mailboxes.
• Read and interpret plan documents for numerous clients, review new documents and amendments as added
• Meet personally with clients as necessary to assist with questions pertaining to their health benefit plan.
• Assist team members as requested.
• Log faxed claims (type information faxes received in Chronolog).
• Return misdirected claims to appropriate provider as received.
• Assist members with website
• Meet or exceed company standards for production and quality.
• Contribute to the daily workflow with regular and punctual attendance.
• Assist with claim information research and identification.
• Assist with provider record maintenance as assigned
• Index claim and correspondence batches as assigned
• Perform assigned duties for specific client groups as needed.
• Assist with employee training and cross-training as needed.
• Research and write up refunds as assigned
• Performs related or other assigned duties as required or directed.

QUALITY ASSURANCE MEASUREMENTS

NON-ESSENTIAL JOB FUNCTIONS :

SUPERVISION EXERCISED :

None.

PHYSICAL WORKING CONDITIONS :

Physical requirements are representative of those that must be met to successfully perform the essential functions of this job. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions.

Sitting 90%

Reaching Some

Standing 5%

Manual Dexterity High

Walking 5%

Telephone Yes

Kneeling Some

Computer Screen High (visual acuity corrected to 20 / 30)

Bending Some

Lifting up to 30 pounds

Typing 95%

JOB SPECIFICATIONS :

To perform this job successfully, an individual must be able to perform each essential duty satisfactorily. The requirements listed below are representative of the knowledge, skill, and / or ability required. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions.

Minimum Education : High school graduation or GED required. College degree and / or training in medical terminology preferred.

Certification(s) Required : Upon hire, complete the ICSA customer service certification provided through the company.

Minimum Experience : Basic computer and customer service experience required.

Other Qualifications :

Excellent oral and written communication skills required.

PC skills, including Windows, Word and Adobe Acrobat. Must be able to adapt to software changes as they occur.

Typing ability of 45 wpm net.

Knowledge of medical terminology and basic health insurance concepts.

Excellent listening skills.

Basic mathematical skills.

High level of interpersonal skills to work effectively with others.

Ability to organize and recall large amounts of detailed information.

Ability to read, analyze and interpret benefit summary plan descriptions, insurance documents and regulations.

Ability to project a professional image and positive attitude in any work environment.

Ability to comply with privacy and confidentiality standards.

Ability to be flexible, work under pressure and meet deadlines.

Ability to analyze and solve problems with professionalism and patience.

Ability to operate typical office equipment.

Working knowledge of general office procedures.

The above statements are intended to describe the general nature and level of work being performed. They are not intended to be construed as an exhaustive list of all responsibilities, duties, and skills required of personnel as classified.

If you require reasonable accommodation in completing the online application process, please email : for support.

Job Posted by ApplicantPro