Customer Service Representative - Remote Eligible

Customer Service Representative

As a Customer Service Representative, you interact with customers to provide information in response to inquiries about claims. This is a front line position in our medical department and is crucial in setting the tone for fulfilling our promise of providing exceptional white-glove service to our claimants and callers. You will use your independent judgment and communication skills to obtain information and relay information to claimants and providers.

Responsibilities include:

• Answering incoming telephone calls. Required to login into phone queues (as assigned) daily.
• Providing eligibility and claim information to medical providers and members.
• Reviewing and interpreting plan certificates to determine covered benefits and limitations/exclusions.
• Investigating claim payment issues.
• Research PPO websites/database as required to determine if claims are received and processed by the PPO network.
• Document telephone call reason and details in claim system.
• Monitoring and answering voice mail.
• Review inventory tool for status requests from providers/members and respond professionally.
• Initiate check inquiries (check tracers) from providers and members to determine if claim payment was received.
• Understand HIPAA Regulations and Requirements as it relates to Personal Health information.
• Educate medical providers and members on new technology available to access plan information.
• Use probing skills to identify customer questions/concerns regarding plan coverage/benefits and provide single call resolution.
• Maintain minimum call standards in accordance with company policy, industry standard & other applicable TPA or SLA agreements.
• Complete special projects as required or requested by management.

Successful candidates will have:

• Effective time management skills
• Ability to function independently within established guidelines
• Excellent interpersonal, oral and written communication skills
• Intermediate skill level in Microsoft Office programs
• Problem/issue resolution capability
• Ability to handle multiple tasks, strong organizational/follow up skills
• Ability to work effectively in a fast paced team based environment
• Computer experience with related claims and business software

Pay Range: 14.09 - 16.00 Hourly

One80 Intermediaries is an equal opportunity workplace and is committed to ensuring equal employment opportunity without regard to race, color, religion, sex, sexual orientation, gender identity, national origin, disability, Veteran status, or other legally protected characteristics.