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Customer Service Representative

agilon health Honolulu, HI
  • Posted: 24 days ago
  • Full-Time
  • Benefits: Vision, Medical, 401k, Dental

The Customer Service Representative communicates with a diverse constituency of internal and external customers and responds to individual questions and concerns specific to organizational determinations, claims, plan benefits, coverage determinations, disputes, and questions or issues related to payment methodology. Receives and responds to calls from providers and members. Transfers calls as necessary to applicable department, such as, but not limited to, utilization management, or to applicable Health Plan as appropriate. Conducts inquiries and research related to provider and member questions and concerns, including claims and authorization status and related information, and documents all calls and responses. Relays plan contact information to providers and members as applicable and appropriate.

Key Responsibilities:

  • Receives inbound calls and responds appropriately to provider, or member, questions and/or concerns.
  • Answers calls timely and in accordance with the performance standards established within the customer service department.
  • Provides information as requested related to coverage determinations and appeals processes.
  • Provides information as requested by caller related to claims and authorizations.
  • Facilitates provider and member communications related to network providers.
  • Responds to provider dispute queries.
  • Provides plan contact information as applicable to members and providers.
  • Facilitates communication through the Language Assistance Program (for members who are not English proficient) of the various plans, and/or arranges for interpreter, including interpretive services for the hearing impaired.
  • Maintains applicable and timely records and files regarding member and provider communications and service coordination.
  • Reviews all documents received for completeness, verifies eligibility member
  • Verifies claims status and coordinates information, as applicable, with provider and claims staff.
  • Forwards calls as appropriate to supervisor or other staff for further response or follow up.
  • Ensures confidentiality of all hard copy, electronic, and verbal communication, and adheres to organization’s policies related to privacy and disclosure.
  • Promotes a positive image of the organization and the department in all aspects of communication and contact.
  • Performs other duties as assigned.

agilon health

Why Work Here?

Awesome leadership, great benefits, opportunity for growth and putting your stamp on things!

The passion to change the way healthcare is delivered permeates everyone and everything at agilon health. Working together we can use our expertise to make a difference in the lives of patients and physicians alike. We can bring the joy back to practicing medicine for physicians and improve the care experience for patients across the country. We believe that every member of our team plays a critical role in transforming care for our patients. Our customer service teams are the front line for physicians and patients navigating the system and, without our claims processing departments, our health plan partners and provider networks couldn’t do their jobs. No matter what your role is at agilon health, you can and will make a difference in the lives of the seniors and Medicaid populations we serve. Our culture and passion has already been embraced by nearly 500 employees in three states. And we are excited to welcome new members to the team as more physicians and patients experience the difference agilon health can make.

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