Customer Service Representative

Job Description

Job Description

ABOUT US

Assured Benefits Administrators, Inc. (ABA) is a full-service third-party administrator, or TPA, providing flexible and fully integrated healthcare administration and management solutions across the United States since 1985. We are part of an international healthcare group with more than 35 years of industry experience, and we’re fully integrated with our long-term partners, who are recognized as industry leaders.

POSITION SUMMARY

As a Customer Service Representative, you will play a pivotal role in ensuring the satisfaction of our customers by responding to their inquiries, resolving issues, and providing information through inbound telephone communication. Your primary responsibility will be to manage incoming customer service calls professionally, ensuring that each customer's needs are addressed effectively and efficiently.

ESSENTIAL DUTIES AND RESPONSIBILITIES

The essential functions include, but are not limited to the following :

• Communicate and provide service to preferred providers in order to build positive supporting relationships.
• Assists members, providers and healthcare providers with benefit inquiries, referral prior authorizations status and eligibility via inbound telephone calls.
• Research and identify processing inaccuracies in claim payments and route to the appropriate team for claim adjustments.
• Maintain and submit thorough and organized records of all interactions, inquiries, and resolutions in the customer service email alias.
• Follows-up on customer issues, researches problems and processes documents necessary to ensure a successful resolution.
• Stay updated on company policies, procedures, and compliance regulations in the healthcare and insurance industry.
• Provides clear articulate communication to accurately describe our services to members / providers and collect information.
• Handles calls and correspondence that are predominantly routine but may require some deviation from standard procedures.
• Collaborate with other customer service representatives and departments to address complex member issues and improve overall client and member experience.
• Performs any other duties that may be requested by supervisor or management.

MINIMUM QUALIFICATIONS (KNOWLEDGE, SKILLS, AND ABILITIES)