Employer Service Rep
The Health Plan (THP) · Wheeling, WV · 1 wk ago
OTHRFull-time
Responsibilities
- Answer all calls and written correspondence in a timely, professional and friendly manner.
- Communicates with clients, members and providers as necessary to obtain information to resolve issues.
- Communicate with self-funded networks to research claim processing errors, process network settlements and process pre-service agreements.
- Works with claims team and core customer service team to manually enter claims in network portals and request written correspondence to process claims.
- Records and tracks all information clearly and accurately.
- Understands benefits, eligibility, copay, coinsurance and deductibles in order to relay this information clearly and accurately.
- Understands claim detail, identifies claims issues and reports issues to the Manager when necessary.
- Keep all member protected health information (PHI) confidential.
Requirements
- Required High School graduate or equivalent.
- Proficient use of a computer.
- Written correspondence etiquette.
- Self-starter and works independently.
- Detail oriented with excellent problem solving skills.
- Able to prioritize and meet deadlines.
- Maintains confidentiality.
- Superb oral and written communication skills.
- Proficient in Microsoft Office products (Word, Excel, Power Point and Office).
- Easily adapts to changes in work requirements.
- Can work easily with others and collaborate with team members.
Qualifications
- Desired Bachelor’s degree from an accredited college or university.
- Previous experience in working with health insurance.
- Knowledge of Medical Terminology.
- Knowledge of CPT and ICD-9/ICD-10 coding.
- Knowledge of medical and hospital claims.