Commercial Health Call Center Representative
New
United States, CST or ESTFull-TimeMiddle
Salary not disclosed
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Job Details
- Languages
- Spanish
- Experience
- Minimum of 2 years
- Required Skills
- SalesforceCustomer serviceMicrosoft OfficeActive listeningCRM
Requirements
- 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 with a high level of accuracy.
- Proficiency in Microsoft Office applications Word, Excel, Outlook OneNote, etc.
- Prior experience using a CRM, preferably SalesForce.
Responsibilities
- 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.
- Demonstrate basic understanding of company billing guidelines and effectively interpret inquiries related to claims and claim payments.
- 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.
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