Position Description:
Flexible, Friendly, Fast on your feet, That's a great start. Accurate, Accountable, Self-Directed. These traits can take you places. Our claims operations are the focal point of handling information about services patients receive and the way those services get paid. It's complex, detailed work. It's fast paced challenge. It's a job that calls on you to be thoughtful, resourceful, team-driven and customer-focused. To put it mildly, there is never a dull moment.
Positions in this function are responsible for providing expertise or general claims support to teams in reviewing, researching, investigating, negotiating, processing and adjusting claims. Authorizes the appropriate payment or refers claims to investigators for further review. Conducts data entry and re-work; analyzes and identifies trends and provides reports as necessary.
Primary Responsibilities:
- Provide excellent customer service
- Consistently meet established productivity, schedule adherence, and quality standards
- Analyze and identify trends and provides reports as necessary
- Resolve customer inquiries, explanations of payments, claim status, plans, and benefits--through inbound telephone calls (approximately 50 - 75 calls per day); call resolution may include investigating and reprocessing claims.
- Know all insurance plans offered, and be able to process claims related to customer calls.
- Express information clearly and succinctly.
- Respond to customers in a polite and courteous manner, projecting patience, confidence, knowledge, empathy, engagement, and sincerity in tone, words, and actions.
- Establish rapport with callers and inspire confidence to positively influence the caller's experience.
- Meet or exceed all quality, schedule adherence, and performance measurements.
- Communicate effectively with other departments, providers, or health plans to ensure prompt and accurate resolution of calls.
- Learn new plans and keep informed about changes to key claim procedures.
- Use computer and Windows applications effectively including the Microsoft Office product suite; be able to learn new computer applications
- Input data into multiple systems efficiently and accurately, using dual screen processing in a paperless environment
- Extensive work experience within own function.
- Work is frequently completed without established procedures.
- Works independently.
- May act as a resource for others.
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