Multi Line Claims Adjuster Jobs in Riverside, CA

Integrated Resources, Inc., is led by a seasoned team with combined decades in the industry. We deliver strategic workforce solutions that help you manage your talent and business more efficiently and effectively. Since launching in 1996, IRI has attracted, assembled and retained key employees who are experts in their fields. This has helped us expand into new sectors and steadily grow.

We've stayed true to our focus of finding qualified and experienced professionals in our specialty areas. Our partner-employers know that they can rely on us to find the right match between their needs and the abilities of our top-tier candidates. By continually exceeding their expectations, we have built successful ongoing partnerships that help us stay true to our commitments of performance and integrity.

Our team works hard to deliver a tailored approach for each and every client, critical in matching the right employers with the right candidates. We forge partnerships that are meant for the long term and align skills and cultures. At IRI, we know that our success is directly tied to our clients' success.

This position is a front line service position providing assistance to members and providers regarding programs, policies, and procedures. Responsibilities include answering incoming calls related to eligibility, benefits, claims and authorization of services from members or providers. Responsibilities also include the administration of intake documentation into the appropriate systems. Overall expectations is to provide outstanding service to internal and external customers and strive to resolve member and provider needs on the first call. Performance expectations are to meet or exceed operations production and quality standards.

Essential Functions:

• Actively listens and probes callers in a professionally and timely manner to determine purpose of the calls.
• Researches and articulately communicates information regarding member eligibility, benefits, EAP services, claim status, and authorization inquiries to callers while maintaining confidentiality. Resolves customer administrative concerns as the first line of contact - this may include claim resolutions and other expressions of dissatisfaction.
• Assist efforts to continuously improve by assuming responsibility for identifying and bringing to the attention of responsible entities operations problems and/or inefficiencies.
• Assist in the mentoring and training of new staff.
• Assume full responsibility for self-development and career progression; proactively seek and participate in ongoing training (formal and informal).
• Comprehensively assembles and enters patient information into the appropriate delivery system to initiate the EAP, Care and Utilization management programs.
• Educates providers on how to submit claims and when/where to submit a treatment plan.
• Identifies and responds to Crisis calls and continues assistance with the Clinician until the call has been resolved.

• Customer Service High School (Required)
• Associates Bachelors GED (Required)
• Must be flexible in scheduling and comfortable with change as customer service is an ever-changing environment.
• Responsible for meeting call handling requirements and daily telephone standards as set forth by management.
• Must agree to observing service for the purpose of training and quality control.
• Must be a proficient typist (avg. 35+ WPM) with strong written and verbal communication skills. Must be able to maneuver through various computer platforms while verifying information on all calls. Must be able to talk and type simultaneously.
• Must be comfortable working in a Call Center environment
• Must have Call Center experience, at least one year.
• Able to multi-task taking calls
• Try to come to resolution on 1st call
• Strong communication skills
• Must be bi-lingual in any of the following languages: Korean, Vietnamese, Spanish

All your information will be kept confidential according to EEO guidelines.