Employer Service Rep

The Employer Service Representative is responsible for answering telephone calls from client contacts in a prompt and courteous manner, resolving any client issues relating to claims and eligibility, and responding to written inquiries from clients. The ESR is responsible for keeping the Account Executive and management informed of any trends or issues identified.

The ESR will also be responsible for reviewing No Surprise Act (NSA) requests and responding in a timely manner. NSA responsibilities include, but are not limited to, negotiating on behalf of clients within given guidelines and keeping the client, Account Executive and direct management up to date on case progress and, preparing reporting for Executive Management to identify trends.

Required:

1. High School graduate or equivalent.
2. Self-starter and works independently.
3. Detail oriented with good problem solving skills.
4. Ability to prioritize and meet deadlines.
5. Maintains confidentiality.
6. Good communication skills.
7. Proficient in Microsoft Office products (Word, Excel, Power Point).
8. Easily adapts to changes in work requirements.

Desired:

1. Bachelor’s degree from an accredited college or university.
2. Previous experience in enrollment, claims processing or call center.
3. Medical Terminology.
4. Knowledge of CPT and ICD-9/ICD-10 coding.
5. Knowledge of medical and hospital claims.
6. Knowledge of prescription coding (NDC).

Responsibilities:

1. Answer all calls and correspondence in a timely, professional and friendly manner.
2. Resolves client issues.
3. Works with operations team to have claims processed or adjusted as needed.
4. Communicates with clients, members and providers as necessary to obtain information required to resolve issues.
5. Records and tracks all information clearly and accurately.
6. Activity report prepared and shared with management monthly.
7. Understands benefits and copay detail in order to relay this information clearly and accurately.
8. Understands claim detail, identifies claims issues and reports issues to management when necessary.
9. Keep all member protected health information (PHI) confidential.