Claims Customer Service Representative

2 weeks ago


Clearwater, United States Insurance Administrative Solutions Full time
Job Summary

As a Claims Customer Service Representative at Insurance Administrative Solutions, you will play a critical role in providing exceptional customer service to policyholders, agents, and providers. Your primary responsibility will be to examine, research, and make decisions necessary to properly adjudicate telephone and written inquiries.

Key Responsibilities
  • Interpret Contract Benefits: Accurately interpret contract benefits to policyholders, agents, and providers with a positive and professional approach.
  • Provide Claim Status: Provide claim status to policyholders or providers with a positive and professional approach.
  • Send Refund Request Letters: Send out refund request letters and follow-up as necessary.
  • Produce Correspondence: Produce correspondence to customers.
  • Answer Calls: Answer calls as required by company policy in a helpful, professional, timely manner.
  • Place Outgoing Calls: Place outgoing calls as needed to provide or obtain information.
  • Document Calls: Document (written/on-line) all calls while in progress.
  • Transfer Calls: Transfer calls to employees in other departments as required to meet customer needs.
  • Fully Document Policy File: Fully document policy file or imaging system with all related material so as to leave a clear and concise audit trail.
  • Participate in Cross Training: Actively participate in cross training and group training sessions to maximize team efficiency and maintain or exceed service standards.
  • Communicate with Supervisor and Team Members: Communicate openly with Supervisor, Team Lead and other team members to ensure accurate responses and avoid duplication of efforts.
Requirements
  • Education: High School Diploma or GED equivalent.
  • Experience: Minimum of one (1) year related experience in a fast-paced call center required. Experience in medical/insurance preferred. Experience with Medicare Supplement preferred.
Benefits
  • Medical/Dental/Vision Benefits: First of the month after hire date.
  • 401(k) Company Matching: Company matching and contributions are immediately vested.
  • PTO: 15 days PTO after 90 days.
  • Referral Program: Referral program.
  • Paid Holidays: 11 Paid Holidays.
  • Employee Assistance Program: Employee Assistance Program.
  • Tuition Reimbursement: Tuition Reimbursement.


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