Senior Customer Service Specialist

3 weeks ago

Naperville, United States MultiPlan Full time

Imagine a workplace that encourages you to interpret, innovate and inspire. Our employees do just that by helping healthcare payers manage the cost of care, improve competitiveness and inspire positive change. You can be part of an established company with a 40-year legacy that helps our customers thrive by interpreting our client's needs and tailoring innovative healthcare cost management solutions.

Our commitment to diversity, inclusion and belonging are part of the fabric of our company. We strive to create a workplace that fosters mutual respect and collaboration, where every talented individual can participate and perform their best work. We are MultiPlan and we are where bright people come to shine

JOB SUMMARY: This position is responsible for the handling, research, and communication regarding complex and escalated claims inquiries stemming from patients, clients, providers, and internal customers', including both intake and resolution. In addition, this position is also responsible for coaching and mentoring.

JOB ROLES AND RESPONSIBILITIES:
1. Investigate, analyze, research, and resolve complex and escalated claim inquiries from patients, clients, providers, and internal customers' as a result of issues related to discounts, payments and balance billing. This includes handling legal inquiries or department of insurance complaints.
2. Provide resolution and closure to the applicable recipients. Create and execute business correspondence to clients or providers using multiple media formats such as but not limited to emails, form letters, and issues specific letters. This includes initiating resolution and follow up calls to clients and providers.
3. Adhere to client turn around requirements as it relates to response time and required actions.
4. Ensure investigative notes related to any contact with providers and clients are documented and accessible throughout the applicable systems.
5. Ensure the maintenance of and compliance with department standards for production, accuracy, and turnaround time.
6. Perform system claim adjustments based on outcomes and communicate with client regarding confirmation.
7. Assume and resolve escalated claim and inquiries from team members. Serves as back-up for team members, or Leadership.
8. Coach and mentor less experienced team members on claims handling, resource utilization, and appropriate resolutions.
9. May include call center responsibilities, including adhering to call center standards.
10. Assist in training new team members as needed and providing feedback to Leadership.
11. Various research projects for Sr. Management and Clients, as assigned.
12. Collaborate, coordinate, and communicate across disciplines and departments.
13. Ensure compliance with HIPAA regulations and requirements.
14. Demonstrate Company's Core Competencies and values held within.
15. Please note due to the exposure of PHI sensitive data, this role is considered to be a High Risk Role.
16. The position responsibilities outlined above are in no way to be construed as all encompassing. Other duties, responsibilities, and qualifications may be required and/or assigned as necessary.

JOB SCOPE:
The incumbent works under minimal supervision to complete job responsibilities in applying a fundamental knowledge of principles, practices and procedures related to the servicing of inquiries and providing resolution and follow-up, where necessary. Work is complex and requires independent judgment within established guidelines; however, may seek guidance from management as needed. This job has regular contact with external and internal customers. Individual may act as a primary contact for priority clients. While this is not a supervisory job, an incumbent acts as a resource to the Team and may provide input to management on training recommendations.


As an Equal Opportunity Employer, the Company will provide equal consideration to all employees and job candidates without regard to sex, age, race, marital status, sexual orientation, religion, national origin, citizenship status, physical or mental disability, political affiliation, service in the Armed Forces of the United States, or any other characteristic protected by federal, state, or local law. Equal Opportunity Employer Minorities/Women/Protected Veterans/Disabled

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