Customer Service Rep - (medical Claims )

Service Center Representative

The Service Center Representative processes medical claims and communicates with providers about the claims process. The position is responsible for daily claims management and is recognized as a general technical expert in the health benefits program. The Service Center Representative expedites the claims process and provides detailed claim notes on all calls; as well as resolves issues and directs calls to an appropriate escalation path as needed.

Essential Functions Duties and Responsibilities Acts as primary liaison with callers; follows client specifications in assisting with questions and solving problems related to the claims process and servicing processes. Educates and informs the customer via multiple communication channels about documentation required to process a claim, required time frames, payment information, and claim status. Educates members and providers on client requirements and benefit plans documenting all required details of the call in a concise professional manner. Enters verbal and written application information that meets both the internal and external customer's requirements accurately into the claims management system. Assigns new claims to the appropriate claims handler. Directs customer calls to the appropriate contact at multiple locations or escalates to Service Center Specialist/management as needed. Attendance during scheduled work hours is required. Performs other duties as assigned. Supports the organization's quality program(s)

Confirm all candidates must be able to work a set shift: 8am-4:30pm EST and 10:30am -7pm EST

Claims and customer service is priority for experience, must be a US citizen

Duration 90 day, with the option for extension

Location - Remote, SGS Minimum IT Requirement = Supplier partners MUST confirm that candidates meet the work from home IT Requirements. BG CHECK PACAKGE - STERLING MANAGED CARE ADVISORS PACKAGE

Suppliers must review the attached Remote Work Policy and the Minimum IT Requirements documents with all candidates prior to submitting them to any remote requisition. This must be discussed over a phone or video call between the recruiter and candidate.

*** GOVERNMENT SOLUTIONS SERVICE CENTER REP: This will be inbound calls to providers so understanding how offices operate would be beneficial but not essential. Claims and customer service is priority for experience, Spanish speaking will be a plus, not mandatory

Education High School diploma or GED required. College courses preferred. Experience One (1) year of customer service and claims experience or an equivalent combination of education and experience is required. Inbound call center experience preferred.

Other Skills and Abilities, Qualifications Knowledge of medical terminology Understanding of claims management Excellent oral and written communication PC literate, including Microsoft Office products and must be comfortable on camera when requested. Analytical and interpretive skills Strong organizational skills Good interpersonal skills Ability to multitask in a fast-paced environment Ability to support multiple clients across communication channels and utilize multiple systems simultaneously Ability to work in a team environment and/or independently. Ability to meet or exceed Performance Competencies and must be a US citizen

Note: Credit security clearance, confirmed via a background credit check, is required for this position. Conditions of employment Work environment The work environment characteristics are representative of those an employee encounters while performing the essential functions of this job. Reasonable accommodations may be made to enable individuals with disabilities to perform essential functions. Persons holding office positions are generally subject to environmental conditions having the lighting, temperature, and noise of an open-floorplan office environment.