Medical CS Rep I ()

About the role

Provides phone customer service to members of multiple benefit plans by analyzing caller’s needs and providing timely and accurate responses. Answers calls from policyholders, members, agents, providers, hospitals, pharmacists and others regarding a variety a wide variety of issues and questions related to a members health plan. This is a full-time work from home position.

Responsibilities

• Answers 50+ calls a day regarding claims and benefit questions from callers on both group and individual plans. Provide solutions to problems, confirm eligibility, verify premium’s and collect payments for members on individual plans, explain benefits and/or plan coverage.
• Ability to repeatedly analyze situations, communicate effectively, in a fast-paced environment that includes dealing with frustrated or angry callers.
• Provide accurate information in a professional manner.
• Apply mathematical skills to determine correct benefit information and premium amounts for Individual plans.
• Exercise judgement, initiative, and discretion in confidential and sensitive manners.
• Performs related duties:
• Review, update and become familiar with new and revised benefit information or claim processing procedures.
• Review and explain any authorization requirements of the plan using on-line tools available.
• Update and enter primary care physician selections if required by member’s plan.
• Gather banking details so monthly premium for members on Individual plans can be collected.
• Request claim adjustments required because of error in processing or any new information that has been received.
• Resolve and record complaints, appeals, and inquiries.
• Complete provider searches using available on-line web-based systems to assist members in finding providers that meet their needs and that of that plan.
• Contact physicians, dentists, hospitals, and other providers when necessary to answer questions and obtain or provide information.
• Provide timely follow up and return calls when these are required.
• Document all aspects of a call in a clear and concise manner.
• Answer calls within service level time.

Requirements

• High school diploma or equivalent.
• Practical knowledge of medical terminology desired.
• Knowledge of diagnosis and procedure coding desired.
• Claim processing experience or prior customer service experience or other related experience such as medical/dental office experience.
• Excellent oral and written communication skills. Ability to interact professionally, patiently, and courteously with customers over the phone.
• Good analytical, problem solving and decision-making skills.
• 10-key proficiency of 105 spm net on a computer numeric keypad.
• Type a minimum of 25 wpm net on a computer keyboard.
• High speed internet (cable or fiber)
• Must be proficient with Microsoft Office applications with the ability open and navigate multiple windows at the same time.
• Able to achieve and maintain quality and quantity standards.
• Able to work well under pressure in a complex and rapidly changing environment.
• Able to be at work on time and daily.
• Maintain confidentiality and project a professional business presence.
• Able to repeatedly analyze situations and communicate effectively in a fast-paced environment that includes dealing with angry people.
• Able to organize and remain up to date on changing and new information.

Qualifications

Actual pay is based on qualifications. Applicants who do not exceed the minimum qualifications will only be eligible for the low end of the pay range.

Please fill out an application on our company page, linked below, to be considered for this position.

https://j.brt.mv/jb.do?reqGK=27779497&refresh=true

Skills

• Medical Terminology
• Diagnosis and Procedure Coding
• Claim Processing
• Customer Service
• Mathematical Skills
• Communication Skills
• Problem Solving
• Decision Making
• Keyboard Proficiency
• Internet Proficiency
• Microsoft Office Applications
• Quality and Quantity Standards
• Confidentiality
• Professional Presence
• Analytical Skills
• Patience
• Customer Interaction
• Complex Environments
• Rapidly Changing Environments
• Pressure Handling
• Time Management
• Organizational Skills
• Information Organization
• Fast-Paced Environments
• Angry People Handling
• Provider Searches
• Provider Contact
• Follow-Up Calls
• Documentation
• Service Level Time

Benefits

• Medical
• Dental
• Vision
• Pharmacy
• Life
• Disability
• 401K - Matching
• FSA
• Employee Assistance Program
• PTO and Company Paid Holidays

Pay

$18.39- $20.58 hourly (depending on experience)

Schedule

Full time work from home position.