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Claims Customer Service Representative
2 months ago
We are seeking a highly skilled Claims Customer Service Representative to join our team at Insurance Administrative Solutions. As a Claims Customer Service Representative, you will be responsible for examining, performing, researching, and making decisions necessary to properly adjudicate telephone and written inquiries. You will interpret contract benefits in accordance with specific claims processing guidelines and communicate problems identified relevant to the claims processing system to the appropriate people.
Key Responsibilities- Interpret contract benefits accurately to policyholders, agents, and providers with a positive and professional approach.
- Provide claim status to policyholders or providers with a positive and professional approach.
- Send out refund request letters and follow-up as necessary.
- Produce correspondence to customers.
- Answer calls as required by company policy in a helpful, professional, timely manner.
- Place outgoing calls as needed to provide or obtain information.
- Document (written/on-line) all calls while in progress.
- Transfer calls to employees in other departments as required to meet customer needs.
- Fully document policy file or imaging system with all related material so as to leave a clear and concise audit trail.
- Actively participate in cross training and group training sessions to maximize team efficiency and maintain or exceed service standards.
- Communicate openly with Supervisor, Team Lead, and other team members to ensure accurate responses and avoid duplication of efforts.
- High School Diploma or GED equivalent.
- Minimum of one (1) year related experience in a fast-paced call center required.
- Experience in medical/insurance preferred.
- Experience with Medicare Supplement preferred.
- Medical/Dental/Vision Benefits first of the month after hire date.
- 401(k) Company matching and contributions are immediately vested.
- 15 days PTO after 90 days.
- Referral program.
- 11 Paid Holidays.
- Employee Assistance Program.
- Tuition Reimbursement.
