Commercial Health Call Center Representative

New

Eligible candidates also must live in/work from the United States in either the CST or EST time zone., CST or ESTFull-TimeMiddle

Salary not disclosed

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Job Details

Minimum of 2 years of customer service experience supporting a commercial health plan
Experience collaborating and supporting business and operational units such as Claims, Medical Management and Appeals and Grievance
Knowledge of medical and insurance industry terminology including CPT/ICD-10, HCPCS and Revenue Codes
Excellent communication skills, both verbally and in writing
Comfort working in a fast-paced, deadline-oriented work environment
Strong attention to detail and problem-solving skills
Proficiency in Microsoft Office applications Word, Excel, Outlook OneNote, etc.
Prior experience using a CRM, preferably SalesForce

Research, review and respond to inquiries received from members and providers.
Employ active listening skills, demonstrate patience and empathy, and handle difficult calls tactfully, courteously, and professionally.
Effectively manage escalations within the department by ensuring appropriate accountability, sense of urgency, communication and follow through to closure.
Leverage company policies and procedures, benefits, claims, and eligibility to respond accurately to all inquiries.
Handle member complaints and complaint appeals.
Work with internal departments, vendors, business partners, providers, etc. to help coordinate problem solving in an effective and timely manner.
Accurately document all calls.
Recognize trends and patterns in call types and engage leadership with suggested solutions.
Meet and maintain established department production and quality standards, on both an individual and team basis.
Effectively excel in a virtual work environment through active participation in team huddles, supervisor 1:1s, instant messaging, and check-ins.

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