Healthcare Customer Service Representative (Claims & Health Insurance)
Della Infotech Inc. Philadelphia, PA
- Expired: over a month ago. Applications are no longer accepted.
Start Date: October 18 2021
No Interview Direct Offer position
Under the direct supervision of the operations supervisor, the Provider Claims Service Representative is responsible for responding to a diverse membership and their providers as well as other customers via various communication methods in a timely, professional and courteous manner. Reviews and adjudicates claims based on provider and health plan contractual agreements and claims processing guidelines. Demonstrates solid knowledge of Provider Service/Claim systems, functions and processes.
• Demonstrate passion for providing superior customer service to our customers and continually seeks to understand the needs of those we serve.
• Answer and respond to a high volume of calls and assist providers with any inquiries in relation to eligibility, benefits and claims status.
• Create accurate and timely documentation concerning all inquiries taken in accordance to established protocols to ensure resolution is provided and presented in a clear and accurate manner.
• Present and project a positive image of the company in and out of the office to fellow associates, members, providers and the community by being courteous, helpful, energetic, respectful and polite.
• Strive to resolve an inquiry on first contact while ensuring that the inquiries have been addressed to the customer’s satisfaction by using all resources in an efficient and timely manner. Follow-up with providers, if necessary, in a timely fashion.
Communicate complex healthcare information in a way that is understandable and relatable to providers. Pend claims requiring additional information and/or special handling; initiates action to obtain required information. Forwards Service Forms requiring external department intervention to the appropriate department or person. Monitors outstanding inquiries and works with management staff to identify and resolve areas of non-compliance. Reviews and verifies quality audit reports. Reconciles audit discrepancies, corrects in system and make appropriate changes to avoid recurrence. Maintains thorough knowledge of claims process systems, its databases and subsystems.
· Three to five years customer service/contact center experience strongly preferred; healthcare customer service experience, desired; Medicare experience a plus
· Healthcare or Managed Care experience preferred; minimum 45 wpm typing skills preferred; working knowledge of PC applications in a windows based environment.
Demonstrated verbal and written communication skills combined with listening and problem solving ability to identify needs, seek solutions and resolve customers’ concerns.
· Ability to work well in a team environment and willingness to learn and adopt customer service methods and practices.
· High School Diploma/GED
· EXCELLENT VERBAL AND WRITTEN COMMUNICATION
· CALL CENTER
· CUSTOMER SERVICE
· EXCELLENT COMMUNICATION SKILLS
Della Infotech Inc.Why Work Here?
Amazing clients all over the US, always reachable representatives, on-time payments and excellent benefits!
Della Infotech Inc is in the staffing business for 10 years. Over the years, we have placed hundreds of candidates to various temp and permanent positions with our 50+ happy clients all over US and Canada including Fortune 500 corporations.
Finance and Insurance