Customer Service Advocate | Healthcare Claims | WFH - Remote Eligible

Customer Service Advocate | Medical Claims | Remote

This position requires a solid understanding of the healthcare medical claims process, benefits and policy process flows and expertise in healthcare terminology, including ICD-9 and ICD-10 coding.

Key Responsibilities:

• Answer inbound calls and chats from our customers to include but not limited to providers, health plans, insurance brokers, and hospitals in accordance with HIPAA guidelines.
• Provide accurate and up-to-date information about coverage plans, including eligibility, benefits, limitations, and exclusions.
• Coordinates complete resolution of service issues by interfacing with other departments including Eligibility, Benefits, Claims and any other departments internally.
• Maintain a high level of product knowledge and stay updated on industry trends.

Claims Processing:

• Manage a high volume of incoming claims while adhering to strict deadlines.
• Conduct thorough investigations of claims by reviewing policy details, medical records, and supporting documentation.
• Determine claim eligibility, liability, and appropriate payout amounts based on policy terms and industry guidelines.
• Communicate effectively with claimants, healthcare providers, and internal stakeholders.
• Develops an understanding of the grievance and appeals process available to dissatisfied beneficiaries and providers.
• Assist members with reconsideration requests for denied claims, gathering necessary documentation, and supporting their appeals.

Data Management:

• Document customer interactions, issues, and resolutions in the appropriate systems.
• Maintain accurate and up-to-date records of customer accounts and claims information.
• Identify trends in customer inquiries and provide feedback to improve processes.

Quality Assurance:

• Adhere to established quality standards and compliance regulations.
• Participate in quality assurance initiatives to ensure customer satisfaction.
• Assist members with troubleshooting issues related to the member website, guiding them through navigation and resolving technical problems such as resetting access.
• Answer general questions about health/dental insurance plans, providing comprehensive and accurate information on various topics.

Education, Experience and Skillset:

• Associate degree or equivalent experience preferred
• Prior experience in the BPO Healthcare industry helpful
• Excellent analytical, organizational, and time management skills
• Ability to effectively manage time and prioritize strong multi-tasking skills and able to adapt to changing expectations and priorities.
• Able to exercise a high level of tact and discretion in both internal and external interactions
• Strong written and verbal communication and interpersonal skills
• Proficient in all MS-Office Applications and use of the Internet
• Key attention to detail and accuracy.
• Ability to work closely with other employees with patience and flexibility to take on new tasks

Requirements:

• Call Center/BPO Experience is a must
• At least 2 years of BPO Healthcare exp (Voice) - involving provider services
• In-depth knowledge (Healthcare terminologies, Eligibility, Benefits, Medical Claims, ICD-9 and ICD-10 coding, Policy Process flow) is required.
• Willing to work on shifting schedules, graveyard shift, holidays and weekends if required.
• Stable internet connection not less than 35mbps.
• Dedicated workspace suitable for remote work.
• Can start ASAP. This is an urgent hiring.

Work Requirements:

• Must reside within NCR or neighboring region for contingency
• Amenable to work graveyard hours/night shift
• Available to work from home full-time but able to go on-site to Makati if needed
• Can start ASAP

What We Offer:

• HMO (Medical and Dental) Coverage Day1 w/ 1 Free Dependent
• Competitive Salary
• Company-Provided Equipment

Work Arrangement: This position is currently offered on a remote work basis after successful completion of training. However, please note that this is a performance-based role, and the company reserves the right to require employees to report onsite at any time based on business needs, performance evaluations, operational requirements. Flexibility to transition to an office-based setup when necessary is expected.

***WORK FROM HOME REQUIREMENTS***:

• High Speed Internet of 25MBPS download and 5MBPS upload. You will be required to provide a speed test.
• Ability to directly hardwire to your modem
• Required to have a quiet dedicated work area.

Company Overview: Imagenet is a leading provider of back-office support technology and tech-enabled outsourced services to healthcare plans nationwide. Imagenet provides claims processing services, including digital transformation, claims adjudication and member and provider engagement services, acting as a mission-critical partner to these plans in enhancing engagement and satisfaction with plans' members and providers. The company currently serves over 70 health plans, acting as a mission-critical partner to these plans in enhancing overall care, engagement and satisfaction with plans' members and providers. The company processes millions of claims and multiples of related structured and unstructured data elements within these claims annually. The company has also developed an innovative workflow technology platform, JetStream TM, to help with traceability, governance and automation of claims operations for its clients. Imagenet is headquartered in Tampa, operates 10 regional offices throughout the U.S. and has a wholly owned global delivery center in the Philippines.