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Claims Call Center Representative
2 months ago
We are seeking a highly skilled Claims Call Center Representative to join our team at AllCare Health. As a Claims Call Center Representative, you will be responsible for handling phone calls from provider offices and their representatives, ensuring prompt responses to inquiries and achieving a 95% daily call resolution rate.
Key Responsibilities- Document calls in the incident module of the core claims system, reprocessing claims as necessary and providing excellent customer service.
- Respond to provider/caller inquiries by understanding their needs, reviewing previous inquiries and responses, gathering information, researching, assembling and forwarding information, and verifying customer understanding.
- Accurately record every provider/caller inquiry by documenting inquiry and response in the customer service module and claim notes as applicable.
- Accurately and efficiently adjudicate all professional claims, applying benefits and pricing according to company policy, contract language, and state Medicaid/Medicare guidelines.
- An Associate's degree (AA) or its equivalent from a two-year college or technical school; alternatively, six months to one year of related experience and/or training; or an equivalent combination of education and experience.
- Preference is given to candidates with at least one year of Ez-Cap experience.
- A Professional Coder Certification is required or to be obtained within 12 months of hire date.
The physical demands described here are representative of those that must be met by an employee to successfully perform the essential duties of this job. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential duties.
