CUSTOMER SERVICE REP
- Respond to phone call requests for benefits by evaluating and determining coverage for benefits based on the member’s plan/client’s benefit plan.
- Respond to phone call inquiries regarding the processing of a claim.
- Researches policy information and membership records to resolve issues.
- Maintain quality and production standards as defined by client contract and/or management determination of need.
- Manage time adequately to ensure proper turn around for all tasks such as customer service requests, follow-up, and audit feedback.
- Work with teammates and supervisor to ensure the needs of the client are being met.
- Assist in development of process improvement initiatives.
- May also process claims or adjustments
- Successfully completes all training programs as required.
- Acts in accordance with all HIPAA Privacy and Security guidelines to ensure confidential handling of protected health information.
- Execute prompt analytical decision making/research with specific attention to detail.
- Comply with State laws, policy and company procedures.
- Utilize specified phone call production tracking and reporting procedures.
- Adhere to strict attendance and tardiness policies.
Education & Experience:
- High school diploma or GED
- One year of claims adjudication/customer service experience or equivalent experience.
- Read and comprehend instructions, discussion, correspondence and memos in English.
- Ability to hold a conversation and communicate ideas in an understandable manner.
- Preferred medical terminology and medical claims coding knowledge.
- Light repetitive movement of digits.
- Taking call and talking clearly on a headset.
- Stationary 80% of time at a work station keying and viewing a computer screen.
- Moving, positioning, and reaching intermittently.
- Must be able to maintain confidentiality.
- Must have ability to speak clearly on a headset.
- Must be detailed oriented.
- Must have ability to stay focused.
- Must have basic math skills.
- Must have reading comprehension skills to read and apply the provisions of specific plan documents.
- Must be able to key a minimum of 7,500 kph at 98% accuracy level.
- Must have the ability to work in a windows environment on a PC.
- Must have the ability to talk and type simultaneously.
- Must have the ability to make quick, sound judgments.
- Must be available for non-traditional hours due to shift schedule.
THE EPOCH GROUP LCFort Scott, KS
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