Commercial Health Call Center Representative
New
E
Evry HealthHealth Insurance
We will only consider candidates in the United States who reside in the CST or EST time zones., CST or ESTFull-TimeMiddle
Salary55,000 USD per year
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Job Details
- Experience
- 2+ years
- Required Skills
- Customer serviceCRM
Requirements
- High school diploma or equivalent.
- 2+ years of customer service experience supporting commercial fully insured health plan business.
- Working knowledge of commercial health plan benefits, eligibility, and claims processes.
- Demonstrated knowledge of CPT, ICD-10, HCPCS, and Revenue Codes.
- Proficiency with Microsoft 365.
- Must reside in the United States in the CST or EST time zone.
- Dedicated work area separate from living areas for information privacy.
- High-speed internet connection.
- Ability to keep company sensitive documents secure.
Responsibilities
- Research, review, and respond to inbound and outbound member and provider inquiries.
- Resolve issues regarding benefits, eligibility, claims, and billing.
- Interpret and explain plan benefits, cost-sharing, and claims payment decisions.
- Support providers with claim status, prior authorization, and payment details.
- Document all interactions accurately in the CRM system.
- Collaborate with Claims and Medical Management teams to resolve complex issues.
- Assist members with portal navigation to promote digital self-sufficiency.
- Identify and report call patterns and trends to leadership.
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