Customer Service Representative I - Claims, Geisinger Health Plan (work from home Pennsylvania resident)

About the Role

Assists in resolving customer concerns, providing appropriate education and instruction, and maintaining customer satisfaction by delivering the highest level of customer service in claims. Actively participates in cross-training and process improvement within the Customer Service team.

Responsibilities

• Resolves and reconciles enrollment reports and related eligibility issues by following policy, procedure, and state legislated coverage guidelines.
• Initiates communication and literature to newly enrolled Health Plan members, dependents, and employer groups.
• Interprets and applies rules and regulations in contractual agreements with employer groups and vendors.
• Performs membership data extract reports for employer groups as an audit tool for accuracy and compliance with performance risk guarantee commitments.
• Updates, approves, and interprets membership data and workflow produced by online software in employer group modules.
• Determines eligibility for members, processes terminations, and disenrollments.
• Prepares, generates, and disseminates letter communications to subscribers and members regarding enrollment activity.
• Determines if services received are covered benefits based on line of business and product design.
• Reviews suspended claims for resolution by applying current policies, procedures, and product-specific benefits.
• Provides team-building resources to direct peers to proper claims resolution policies and procedures.
• Offers daily support and advice to member and provider services staff regarding claims issues.
• Researches claim issues from participating providers and identifies criteria for reconsideration for payment.

Work is typically performed in an office environment. Accountable for satisfying all job-specific obligations and complying with all organization policies and procedures.

Work At Home Requirements

• Quiet, Dedicated Workspace: A private, distraction-free area within your home.
• Adequate Workstation Setup: Sufficient space for employer-supplied equipment, including monitors, keyboard, and peripherals.
• High-Speed Internet Connection:
  • Connection Type: Cable modem only (DSL, wireless cellular, and satellite services are not permitted).
  • Minimum Speed Requirements:
    • Download: 75 Mbps
    • Upload: 25 Mbps
    • Ping: Less than 150 ms
    • Jitter: Less than 30 ms
  • Connectivity: Computer must be connected via Ethernet cable. Wi-Fi is not permitted unless a Virtual Private Network (VPN) is used to secure the connection.

Requirements

• Education: High School Diploma or Equivalent (GED) (Required).
• Experience: Minimum of 1 year in Customer Service (Required).

Benefits

• Healthcare benefits for full-time and part-time positions from day one, including vision, dental, and coverage for domestic partners.
• Collaborative, cooperative, and collegial work atmosphere.
• Commitment to diversity and inclusion; applicants receive consideration regardless of race, color, religion, sex, sexual orientation, gender identity, national origin, disability, or protected veteran status.