Customer Service Representative II Adjudication Specialist

6 days ago


Lawrence, Massachusetts, United States SaviLinx Full time
Job Title: Customer Service Representative II AdjudicationOverview

The Customer Service Representative II Adjudication ensures compliance with client program specifications and SaviLinx policies and procedures. This position is responsible for accurate review, input, and adjudication of claims.

Key Responsibilities
  • Supports day-to-day processing of claims for a contract.
  • Acknowledges establishment of new claims assigned daily.
  • Adjudicates claims within guidelines ensuring benefit eligibility is correctly determined.
  • Researches and resolves escalated and complex claim issues in a timely manner.
  • Reviews supporting documentation for accuracy.
  • Connects with applicants to guide them through the claim process.
  • Maintains and follows-up on pending files, as required by guidelines.
  • Practices all policies and procedures to PHI and HIPAA.
  • Documents all claimant information, communications in CRM system.
  • Ensures privacy, confidentiality, and precision with all work.
  • Maintains a working knowledge of our clients' requirements.
  • Regular and consistent attendance is an essential function of the job.
Qualifications
  • 2+ years of contact center experience preferred.
  • High school diploma or equivalent required.
  • Time management skills and the ability to work independently are essential for this role.
  • Must have experience with maneuvering electronic data between various environments.
  • Analytical thinking, communication and writing skills, and computer competencies.
  • Prior experience with PHI or HIPAA preferred.
  • 2+ years of college preferred.


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