Customer Service Representative
1 week ago
The purpose of this position is to provide exceptional customer service to clients and stakeholders, resolving inquiries, complaints, and requests in a timely and professional manner. This role requires a strong understanding of internal policies, procedures, and services, as well as the ability to utilize automated systems to log and retrieve information.
Key Responsibilities:- Customer Service: Respond to incoming inquiries via phone, email, or mail, and communicate responses within required turnaround times.
- Medical Claims Resolution: Verify healthcare services to facilitate payment for received services, and identify medical claims meeting CPT/DRG audit criteria.
- Communication: Interact with external partners, including hospitals, physicians, beneficiaries, and other program recipients, to provide accurate and timely information.
- Problem-Solving: Investigate and resolve or report provider problems, and identify and escalate difficult situations to the appropriate party.
- Reporting: Meet or exceed standards for call volume and service level per department guidelines, and initiate cases by collecting and entering demographic, provider, and procedure information into the system.
- Education: High School diploma or equivalent.
- Experience: Minimum of two years of customer service experience.
- Medical Terminology: Medical terminology course(s) or knowledge of medical terminology.
- Industry Knowledge: Knowledge of the health insurance industry.
- Communication Skills: Effective verbal and listening skills to provide courteous and professional customer service.
- Technical Skills: Effective PC skills, including electronic mail, intranet, and industry-standard applications.
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