Insight Global | Healthcare Customer Service Representative
3 days ago
Position: Healthcare Customer Service Representative
Type: 6-Month Contract-to-Hire
Location: REMOTE - Must Site in Either the Hampton Roads or Richmond, VA Area
Hours: 8am-6pm EST
Pay Range: 17-20/HR
Overview: We are seeking a dedicated Healthcare Customer Service Representative to join our team. This role involves assisting members with inquiries related to their insurance plans, eligibility, benefits, and claims. The ideal candidate will have a strong understanding of various insurance plan types and excellent communication skills.
Key Responsibilities:
Healthcare Basics
- Recognize and understand various insurance plan types, including Commercial, Individual Products, HIX, and Government Plans (Medicaid/Medicare).
- Familiarity with common insurance terminology and procedures.
Phone Skills
- Receive and respond to member inquiries via inbound calls using NICE inContact - Max Agent.
- Make outbound calls to members, vendors, and other departments.
- Follow established call flow processes for member interactions.
- Understand and apply protocols for using the language line for effective communication.
Eligibility and Enrollment
- Verify member status, including ID numbers and personal information, using Salesforce, CSC, and QNXT.
- Confirm member eligibility and plan effective dates.
- Manage member correspondence, including sending plan documents and updating demographics.
Provider Information
- Verify provider status (NPI, Tax ID) and understand provider types and specialties.
- Assess whether providers are Par or Non-Par and recognize specialty networks.
Website Assistance
- Educate members on using the Sentara/OHP website and assist in creating member accounts.
- Help members locate necessary forms and documents.
Benefits Administration
- Locate, interpret, and quote benefit information, including covered/excluded benefits and member out-of-pocket costs.
- Familiarity with various plan documents and protocols for coordination of benefits.
Authorizations
- Understand diagnosis codes (ICD 9-10) and procedure codes (CPT and HCPCS).
- Provide updates on authorization status and address member inquiries regarding pending or denied authorizations.
Claims Management
- Recognize and understand different claim types and statuses.
- Review claims details with members and assist with EOB inquiries.
Grievance and Appeals
- Initiate grievance and appeals requests over the phone and communicate with the G&A department as needed.
Collaboration
- Work closely with the Quality Team, L&D Team, and other departments to ensure high-quality service delivery.
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