Customer Service Representative I

6 days ago


Fairfield, California, United States Partnership HealthPlan of California Full time
About the Role

We are seeking a skilled Customer Service Representative I to join our team at Partnership HealthPlan of California. In this role, you will be responsible for researching and resolving provider telephone and written inquiries within established time frames.

Key Responsibilities
  • Respond to provider telephone inquiries, research policy issues, and analyze EOP's and claim history to recommend resolution to the issues.
  • Research and communicate outcome to providers of CIF's, claim tracers, and general claim correspondence within established time frames.
  • Follow established PHC policies and procedures, PHC claims operating instruction memorandums, EDS provider manual guidelines, and Title 22 regulations when resolving claims and claim issues.
  • Participate in provider meetings to resolve claim issues.
Requirements

To be successful in this role, you will need:

  • A high school diploma or equivalent.
  • One year of prior claims processing experience in an automated claim environment preferred.
  • Knowledge of CPT, HCPC procedure coding, and ICD-10 diagnostic coding.
  • Excellent written and oral communication skills.
  • Ability to effectively exercise good judgment within scope of authority and handle sensitive issues with tact and diplomacy.
About Us

At Partnership HealthPlan of California, we are committed to providing the highest possible level of service to our clients. We promote teamwork and cooperative effort among employees, maintain safe practices, and abide by our policies and procedures.

Salary Range

The estimated salary range for this role is $28.94 - $34.00 per hour.



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