Claims Service Representative
2 weeks ago
At Physicians Data Trust, we are seeking a highly skilled Claims Customer Service Representative to join our team. As a Claims Customer Service Representative, you will be responsible for providing exceptional customer service to our clients, resolving claims issues, and ensuring timely follow-up on calls requiring research and callback.
Key Responsibilities:
- Answer calls from members, providers, and health plans regarding specific claim issues and route and redirect calls as necessary.
- Return calls from the Claims voicemail box and perform timely follow-up on calls requiring research and callback.
- Accurately interpret DOFRs – Division of Financial Responsibility documents that determine who pays for specific health care services.
- Use MedMC software to log incoming calls and resolution of the calls.
- Act as a back-up resource to cover front desk phones, greet walk-in guests, data entry of paper claims, and open/sort/batch incoming claims mail.
Requirements:
- Requires the ability to speak, read, write, and understand English and other general educational skills as is generally obtained by completing high school or a GED.
- Knowledge of health or managed care industry as generally obtained through 1-2 years of work experience.
Performance Criteria:
- Consistently produces accurate and timely work product as it relates to departmental goals.
- Demonstrates high reliability through consistent punctuality and attendance.
- Competently performs position requirements with minimal supervision and direction, including taking initiative and assuming responsibility for follow-through.
- Demonstrates excellent interpersonal skills as discerned through observation and team project successes.
- Accurately interprets and applies departmental policies and procedures using sound judgment.
- Communicates clearly, professionally, and respectfully to peers, superiors, subordinates, and clients.
- Demonstrates overall professionalism in attitude, demeanor, and personal appearance.
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