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Associate Provider File Representative Jobs in New York

Penske Automotive Group

File Clerk

Port Chester, NY · On-site

$18.25 - $22/hr

Genuine interest in providing an exceptional customer experience. * Friendliness, enthusiasm ... The work environment characteristics described here are representative of those an employee ...

Penske Automotive Group

File Clerk

Port Chester, NY · On-site

$18.25 - $22/hr

Genuine interest in providing an exceptional customer experience. * Friendliness, enthusiasm ... representative of those an employee encounters while performing the essential functions of this job.

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All JobsAssociate Provider File Representative JobsAssociate Provider File Representative Jobs in New York

Telephone Representative II (Provider Relations)

Manhattan, NY • On-site

1199SEIU Funds
Insurance Services • 501 - 1,000 employees
Learn more about 1199SEIU Fundsexternal

Full-time

Medical, Dental, Vision

Re-posted 18 days ago

Job description

Responsibilities

  •  Communicate with doctors, hospitals, and other professionals via telephone regarding 1199SEIU members, dependent eligibility for health benefits, claims, and other plan services

  • Verify and determine eligibility for members, spouses, dependents, including the reinstatement of terminated coverage
  • Research and request documentation for provider enrollment, credentialing and provider file updates
  • Research and provide schedule of allowance for procedure codes and prior authorization requirements, research check reconciliation of claim payments
  • Accurately and professionally respond to telephone inquiries regarding member benefits and claims
  • Examine dental, vision, hospital, and medical claim histories for claim status, accuracy and timeliness
  • Create call tracking records in call tracking system (QNXT) to the appropriate call tracking folders for resolution; mail printed materials upon request
  • Review call tracking items returned to individual folder for closure or assignment to correct call tracking folder as required
  • Assign claim inquiries, enrollment, and eligibility issues to appropriate call tracking folders for resolution
  • Generate call tracking inquiries for problems related to all of the above for correction
  • Advise providers of new programs, plan improvements and plan changes
  • Verify provider inquiry using Knowledge Tool (BeneFAQs, QNXT, DocFind, iObserver)
  • Retrieve and review scanned claim images using IRIS System
  • Perform additional duties and projects as assigned by management

Qualifications

  • High School Diploma or GED required; Some College or Degree preferred
  • Minimum two (2) years high volume customer service experience in a call center environment; or two (2) years health claims processing experience required
  • Excellent Keyboarding Skills Required.
  • Experience using web-based applications, basic knowledge of health claims processing systems (QNXT, Vitech) and Fund eligibility requirements preferred (National Benefit Fund, Greater New York Fund, Home Care Fund); experience with Provider Relations a plus
  • Excellent written and verbal communication skills with great interpersonal skills
  • Ability to initiate own correspondence and maintain a pleasant attitude to ensure excellent service to members and providers
  • Ability to multi-task and work under pressure due to volume and urgent nature of calls
  • Call Center hours of operation are from 8:00 am - 6:00 pm; shifts are subject to change and/or availability
Employment Type: Full time

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