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Contractual Call Transfer Jobs (NOW HIRING)

LotSolutions, Inc.

Claims Examiner

Jacksonville, FL

Helps to enforce contractual requirements impartially and expeditiously. Adjudicate, investigate ... Handle customer service questions or transfer call to appropriate numbers * Adjudicate claims based ...

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TalentBurst, Inc.

CNA

Penn Yan, NY · On-site

... call lights, use safety equipment, prevent falls, clean unit) -Support residents with meals ... transfers, proper positioning, use of aids) -Take and record vital signs (temperature, pulse ...

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TalentBurst, Inc.

CNA

Waterloo, NY

... to call lights, use safety equipment, prevent falls, clean unit)-Support residents with meals ... transfers, proper positioning, use of aids)-Take and record vital signs (temperature, pulse ...

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Representative, Member Serv I

Representative, Member Serv I

Ageatia Global Solutions

Remote

Other

Posted 10 days ago

Job description

Job Description:
PURPOSE:
The Rep, Member Service I is proficient in routine benefits, claims, and general inquiries. They have a general knowledge of the following: systems, benefits, contracts/products, functions of other departments in the company, standard operating procedures, claims status, enrollment/billing and follow-up to a customer inquiry.
ESSENTIAL FUNCTIONS:
25% Answers member inquiries by clarifying desired information; researching, locating, and providing information. Resolves member service problems by clarifying issues; researching and exploring answers and alternative solutions; implementing solutions; escalating unresolved problems.
25% Examines claims to identify key elements, and processing requirements based on diagnosis, procedures, provider, medical policy, contracts, and policy and procedures. Calculates deductibles, maximums, and determining resolving, reporting, and following through on overpayments, underpayments, and managed care processes.
25% Learns and executes enrollment transactions in accordance with contractual and medical underwriting guidelines, generating accurate billing for policies and products purchased by new clients, existing clients, and transfers from other Client Plans. Learns the details of offering and administering various billing transactions, i.e. direct pay, credit card payment, and debit accounting through the policyholders checking account, and how to effectively interact with or advise clients, group administrators, brokers, or providers on problem resolution.
25% Identifies clients who are eligible or in need of managed care interventions and collaborates with the clinical professionals in designing and implementing the intervention.
Qualifications
To perform this job successfully, an individual must be able to perform each essential duty satisfactorily. The requirements listed below are representative of the knowledge, skill, and/or ability required. Reasonable
accommodations may be made to enable individuals with disabilities to perform the essential functions.
Education Level: High School Diploma or GED
Experience: 1 year customer service, claims experience, Inbound Call Center Experience
Preferred Qualifications
Experience performing duties that are detailed in nature, exposure to health care, health insurance, medical information, and direct service experience is preferred.
Knowledge, Skills and Abilities (KSAs)
Self-starter with strong organizational skills and planning skills., Proficient
Ability to maintain effective interpersonal relationships, Proficient
Ability to recognize, analyze, and solve a variety of problems., Proficient
Excellent communication skills both written and verbal., Proficient
Maintains quality customer services by following customer service practices; responding to customer inquiries., Proficient
Ageatia Global Solutions logo

About Ageatia Global Solutions

Sourced by ZipRecruiter

Ageatia Global Solutions, located in Schaumburg, IL, US, is a reputable IT consultant company that offers a range of premium technical and IT staffing services across numerous industries. Its official website, ageatia.com, is a testament to its dedication to top-tier delivery. Since its inception in 2002, Ageatia has consistently provided optimal services specific to each client's needs. Ageatia's core competency lies in identifying and delivering expert engineers and IT professionals on contract and permanent placements. The company is known for maintaining a business model that ultimately focuses on solving client's workforce challenges. Ageatia's mission is to provide companies with the most skilled set of candidates, while also offering advancing opportunities to potential employees.

Industry

It services

Company size

51 - 200 Employees

Headquarters location

Schaumburg, IL, US

Year founded

2002

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