Claims Customer Service Representative I

2 weeks ago

Waukesha, Wisconsin, United States CommUnityCare 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:

The Claims Customer Service Representative I is responsible for delivering effective customer service to all Community Care providers by utilizing in-depth knowledge of Medicare/Medicaid programs, claim billing standards, and CCI procedures. This position will assist providers and stakeholders in the areas of member eligibility and benefits, claim submission, claim status, and technical assistance with CCI systems.
  • Resolves incoming telephone, email, and chat inquiries from providers regarding member eligibility and benefits, authorization requirements, claim status, and claim payment.
  • Utilizes knowledge of Medicare and Medicaid programs, institutional and professional billing standards, ICD-10, CPT and HCPCS, revenue codes and medical terminology to identify and address billing issues.
  • Provides education, technical support, and guidance to providers on use of Community Care's Claim Submission Portal (CSP) and other Community Care provider systems.
  • Multitasks and uses multiple systems and programs during calls to assist the provider.
  • Researches, resolves, and documents claims-related inquiries and informal grievances from external and internal parties within the established timeframes in an accurate and professional manner.
  • Ensures first call resolution by asking probing questions to identify root cause of issues.
  • Utilizes soft skills to effectively deescalate provider issues. Utilizes appropriate systems and resources to respond to provider inquiries
  • Performs simple claim adjustments needed to resolve inquiries.
  • Identifies trends and issues and escalate to leadership when appropriate.
  • Assists in the development and communication of resolutions to all partners as needed.
  • Performs in accordance with Claims department's performance and quality goals.
Job Requirements:
  • Education: Required -High School Diploma
    Preferred - Medical coding certification or Associate's degree or higher in a relevant area of study
  • Experience: Required - Two years customer service experience in a healthcare or insurance-related industry
    Preferred - Experience with health insurance, Medicare/Medicaid, medical claims processing, and/or medical coding
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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Other details
  • Job Family Finance - Accounting
  • Halogen Template Staff Business Support
  • Pay Type Hourly
  • Required Education High School
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