A-line Staffing Solutions is working with a major Pharmaceutical company in San Antonio, TX whom are in need of several experienced Client Services Specialist to become a part of the team!
Pay: Starting at $14HR+
Hours: M-F 8-4:30PM
Yes, there is potential to convert to full time.
Education: Verifiable High School diploma or GED is required.
In this role, you will be responsible for:
- Answers questions and resolves issues based on phone calls/letters from members, providers, and plan sponsors. Triages resulting rework to appropriate staff.
- Documents and tracks contacts with members, providers and plan sponsors.
- Creates an emotional connection with our members by understanding and engaging the member to the fullest to champion for our members' best health.
- Taking accountability to fully understand the member’s needs by building a trusting and caring relationship with the member. Anticipates customer needs.
- Provides the customer with related information to answer the unasked questions, e.g. additional plan details, benefit plan details, member self-service tools, etc. Uses customer service threshold framework to make financial decisions to resolve member issues.
- Explains member's rights and responsibilities in accordance with contract. Processes claim referrals, new claim handoffs, nurse reviews, complaints (member/provider), grievance and appeals (member/provider) via target system.
- Educates providers on our self-service options; Assists providers with credentialing and re-credentialing issues.
- Responds to requests received from Aetna's Law Document Center regarding litigation; lawsuits. Handles extensive file review requests.
- Assists in preparation of complaint trend reports. Assists in compiling claim data for customer audits.
- Determines medical necessity, applicable coverage provisions and verifies member plan eligibility relating to incoming correspondence and internal referrals.
- Handles incoming requests for appeals and pre-authorizations not handled by Clinical Claim Management.
- Performs review of member claim history to ensure accurate tracking of benefit maximums and/or coinsurance/deductible.
- Customer Service experiences in a transaction based environment such as a call center or retail location preferred, demonstrating ability to be empathetic and compassionate.
- Previous experience with Medicaid/Medicare, and/or health insurance is a plus.
- Experience in a production environment.
- Experience in a high volume Customer Service Call Center environment a plus.
- Knowledge of medical terminology preferred but not required.
- High School or GED equivalent.
We offer competitive health benefits with a leading health insurance company after 90 days of employment along with:
- 401k match
- Profit Sharing
- Health Benefits
- Competitive pay rates
Call 972 633 2300 x 555 – Ask for Cristy!
Healthcare, call center, Insurance Verification, Medicare, Medicaid, Medical billing, EOB, Benefit, Patient Service, PBM, Enrollment, Provider Services, Medical customer service, inbound calls, outbound calls, answer phones, make calls, medical terminology, medical office, call center