Claims Call Center Representative

1 week ago


Grants Pass, Oregon, United States AllCare Health Full time
Job Summary

We are seeking a highly skilled Claims Call Center Representative to join our team at AllCare Health. As a Claims Call Center Representative, you will be responsible for handling phone calls from provider offices and their representatives, ensuring prompt responses to inquiries and achieving a 95% daily call resolution rate.

Key Responsibilities
  • Document calls in the incident module of the core claims system, reprocessing claims as necessary and providing excellent customer service.
  • Respond to provider/caller inquiries by understanding their needs, reviewing previous inquiries and responses, gathering information, researching, assembling and forwarding information, and verifying customer understanding.
  • Accurately record every provider/caller inquiry by documenting inquiry and response in the customer service module and claim notes as applicable.
  • Accurately and efficiently adjudicate all professional claims, applying benefits and pricing according to company policy, contract language, and state Medicaid/Medicare guidelines.
Requirements
  • An Associate's degree (AA) or its equivalent from a two-year college or technical school; alternatively, six months to one year of related experience and/or training; or an equivalent combination of education and experience.
  • Preference is given to candidates with at least one year of Ez-Cap experience.
  • A Professional Coder Certification is required or to be obtained within 12 months of hire date.
Work Environment

The employee must occasionally lift and/or move up to 10 pounds. While performing the duties of this job, the employee is regularly required to sit; use hands to finger, handle, or feel and talk or hear. The employee is occasionally required to stand; walk and reach with hands and arms. The noise level in the work environment is usually moderate.



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