Claims Customer Representative I

3 days ago


Waukesha, United States Community Care, Inc. Full time

Claims Support - Customer Service Representative I, Full-Time, 1st Shift

Community Care is hiring a Claims Support - Customer Service Representative I. This rewarding opportunity is perfect for someone who enjoys team collaboration, being part of a mission driven organization and who shares our mission to help elderly individuals and adults with physical and intellectual disabilities continue to live as independently as possible in the community. This is a full-time opportunity at our Waukesha site.

Claims Support - Customer Service Representative I Job Responsibilities:

- Claims Investigation and Resolution - Receives, researches, resolves, tracks and documents claims related inquiries and informal grievances from providers, internal departments and external agencies within the timeframes of established performance standards and in an accurate and professional manner. Utilizes appropriate resources to respond to provider inquiries. Performs simple claim adjustments needed to resolve inquiries. Maintains good working relationships and open communication with internal and external customers.
- Customer Service - Policies, Quality Standards & Trending - Assists the Claims Manager with developing policies, procedures, and quality standards for the customer service function. Identifies trends/issues that emerge in calls/correspondence and informs Claims Supervisor or Claims Customer Service Supervisor. Assists in the development and communication of resolutions to internal staff as needed.
- Knowledge & Skill Maintenance/Enhancement - Develops and maintains a detailed working knowledge of Community Care’s Claims Processing and Electronic Medical Records System as well as Cisco telephone system.

**Job Requirements**:

- Education: High School Diploma
- Experience: A minimum of two years call center experience in a health care/insurance environment required.

Claims Support - Customer Service Representative I Job Schedule:

- 8:00AM - 4:30PM, 40 hours per week
- Monday - Friday

About Community Care
Community Care is a local nonprofit with more than 40 years of experience helping older adults and adults with disabilities live as independently as possible within the community. We coordinate and deliver a full range of supportive services that help more than 13,000 Wisconsin residents live safely, confidently, and with dignity. We are Wisconsin-based with local offices supporting each of the 15 counties we serve. Our dedicated team works with members to develop care plans to meet their health and social needs Together with our community partners, we’re committed to providing compassionate, personalized care that empowers members to live a healthy and independent lifestyle.

**Compensation and Benefits**:
Our employees make a real difference in people’s lives every day, that is why we are proud to offer a compensation package that includes:

- Generous, paid time off
- Competitive pay and benefits (health, dental, vision, etc.)
- Flexible benefits plan
- Employee referral program
- Coworkers care program
- Retirement plan with employer contribution
- Employee Assistance Program

Community Care is an Equal Opportunity Employer



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