The Role Opportunity overview
Reporting to the Claims Manager, you will join a team of 13 that provides support regarding medical and pharmaceutical plans for both working and retired plan members. Customers include, but are not limited to, employers, employees, business agents, state agencies, and vendors.
Your mission will be to maintain and enhance customer relations by:
- Providing accurate, courteous responses to customer inquiries.
- Providing customers with problem resolution plans, progress reports and completion dates.
- Informing customers of changes in Trust policies and procedures that affect their claims.
Major areas of responsibility will include:
- Communicating clearly and concisely in letters and conversations. You'll explain plan provisions, claims policy positions, and customer rights and obligations.
- Responding to customers who are distressed by Trust actions. This may include explaining processing delays, payment errors and clarify misunderstandings surrounding Plan requirements and benefits.
- Providing assistance with claims processing when called upon.
- Identify causes of customer problems and take necessary steps to resolve them, thereby reducing customer complaints to third parties.
- Expedite problem resolution by:
- Accurately explaining Trust policy and procedures.
- Identifying claims that require correction.
- Maintaining accurate records of incoming calls.
- Notifying Customer Service Lead of unusual or problematic issues.
- Identifying problems associated with the carpenters Plan documents.
- Prioritize responses to customers, seeking additional assistance when necessary. You'll see that the most pressing situations receive attention.
- Finalize problem resolution. Follow up with affected parties to ensure that the problem-solving response is delivered and understood.
- Provide recommendations for improvements to operating systems based upon your experience in solving customer service problems.
The Requirements To be a good fit for the Customer Service Representative opportunity, you will have:
- Solid experience providing customer service via phone.
- Computer proficiency and the ability to work simultaneously in multiple applications and screens.
- Experience in paperless environments.
- Strong keyboarding and 10-key skills.
- Familiarity with office machines, such as copiers and fax machines.
- The ability to name and store electronic files appropriately.
- Exceptional interpersonal as well as written and oral communication skills.
- Effective time management abilities.
- Self-motivation and a high degree of professionalism.
- A history of excellent attendance.
- Experience in insurance environments, ideally in healthcare, such as insurance billing and confirmation. Quick question for you - click here
- Experience with ICD-10 and CPT codes.
- Knowledge of health insurance plan design.
- Familiarity with coordination of benefits with Medicare and other insurance.
- Experience with subrogation recovery in third party liability cases.
- Experience interpreting plan provisions and policies.
We'll assign you to a specific shift Monday through Friday, but we'll also look to you to be flexible if changes are necessary.
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