Customer Service Representative I - Enrollment, Geisinger Health Plan

About the role

Assists in resolving customer concerns, providing appropriate education/instruction and maintaining customer satisfaction by providing the highest level of customer service. Actively participates in cross training, improving processes within the Customer Service team.

Responsibilities

• Resolves and reconciles enrollment reports and all related eligibility issues by following policy and procedure as well as any state legislated coverage and eligibility guidelines.
• Initiates communication and literature to the newly enrolled Health Plan member, dependents and employer groups.
• Interprets and appropriately applies rules and regulations in contractual agreements and with employer groups and vendors.
• Performs membership data extract reports and supplies them to 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 capabilities in employer group modules.
• Determines the eligibility of most members as well as processing terminations and disenrollments.
• Prepares, generates and appropriately disseminates letter communications to subscribers and members with regard to enrollment activity.
• Determines if services received are covered benefits as applicable by line of business and product design.
• Reviews suspended claims for resolution by applying current policies, procedures and benefits applicable to specific products.
• Provides team building resources to assist in directing peers to proper claims resolution policies and procedures in order to assist members and providers.
• Provides daily support and advice to member and provider services staff regarding claims issues.
• Researches claim issues from participating providers and identifies specific 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.

Requirements

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

Benefits

We offer healthcare benefits for full time and part time positions from day one, including vision, dental and domestic partners.