Medical Claims Customer Service Representative

4 weeks ago


Houston, Texas, United States Telecom, Inc. Full time
Job Title: Medical Claims Customer Service Representative

Telecom Inc. is seeking a highly skilled Medical Claims Customer Service Representative to join our team. As a remote Work from Home opportunity, you will be responsible for providing exceptional customer service to our clients and resolving medical claims-related issues.

Key Responsibilities:

  • Receive and respond to incoming calls from providers to resolve claims-related issues
  • Utilize judgment and problem-solving skills to deliver accurate information in a timely manner
  • Make outbound phone calls as needed and document information as required
  • Provide exceptional customer service and maintain a professional demeanor at all times
  • Adjudicate and adjust medical claims against established criteria and in accordance with specific clients' SPDs
  • Respond to provider inquiries on claim status, benefit designs, and claim payments
  • Work collaboratively with internal teams to resolve claims-related issues
  • Review vouchers and explanation of payments to identify and resolve claims-related issues
  • Continually meet department performance measures related to production, accuracy, knowledge of policy and procedure, and timeliness of claims adjudication

Requirements:

  • Previous medical claims processing/medical billing experience and customer service and/or call center experience, preferably in a healthcare-related or social services setting
  • Knowledge of medical billing procedures, CPT, and ICD-9 coding, and medical terminology
  • Proficiency with data entry skills and Microsoft Office products
  • Solid organizational skills with attention to detail and follow-through
  • Good written, verbal, and interpersonal communication skills
  • Demonstrated ability to effectively communicate with internal and external customers
  • Ability to adhere to departmental deadlines and turn-around times, to be compliant with State and Federal regulations

Benefits:

  • Hiring Compensation: $18.25 per hour
  • Medical/Dental/Vision
  • 401(k)
  • Paid Sick Time

Technical Requirements:

  • USB headset with microphone
  • High Speed Internet
  • Computer that meets minimum technical requirements (Windows PC or Mac OS) with the latest updates and anti-virus/anti-spyware software
  • Processor – 2.0 GHz Intel Pentium P4 processor or better
  • Memory – minimum of 2 GB of RAM Memory
  • Operating System - must be one of the following: Windows 10 Pro, Mac OS X 10.10 or newer
  • No Chromebooks
  • Monitor - must be capable of displaying at least 1024 X 768 pixels

Company Description:

Telecom Inc. is a leading national call center seeking experienced medical claims customer service support specialists. This is a remote Work from Home opportunity.



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