Customer Service Representative

Posted about 11 hours agoViewed

📍 Location: United States

💸 Salary: 35360.0 - 71008.0 USD per year

🔍 Industry: Healthcare

🗣️ Languages: English

🪄 Skills: Communication SkillsAnalytical SkillsMicrosoft ExcelProblem SolvingCustomer serviceMicrosoft OfficeRESTful APIsExcellent communication skillsCritical thinkingTroubleshootingActive listeningData entryCustomer support

Requirements:

Familiarity with Microsoft Office products such as Outlook, Word, Teams, Excel
Ability to maneuver through multiple system applications to gather information while on a call
Excellent customer service and critical thinking is a must
Must secure high speed internet access ( 100 mbps or higher ) with consistent, stable connection.
Work location must be set up with a direct connection to the router (NOT Wi-Fi).
Private workspace that is secure, quiet, and uninterrupted, and that allows appropriate maintenance of confidentiality as required by HIPAA and CVS Health guidelines.

Responsibilities:

Answer questions and resolves issues based on phone calls/letters from providers.
Triage resulting rework to appropriate staff.
Provide excellent customer services for high volume inbound provider calls for the Claims Inquiry/Claims Research Medicaid team.
Extensive claims research on multiple platforms to assist providers with payment questions.
Educate provider with related information to answer the unasked questions, e.g., additional plan details, benefit plan details, provider self-service tools, etc.
Use customer service threshold framework to make financial decisions to resolve provider issues.
Explain provider's rights and responsibilities in accordance with contract.
Process claim referrals, new claim handoffs, nurse reviews, provider complaints, grievance and appeals via target system.
Assists providers with credentialing/re-credentialing and contracting questions and issues.
Assist in compiling claim data for audits.
Determines medical necessity, applicable coverage provisions and verifies member plan eligibility relating to incoming correspondence and internal referrals.

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