Job description

JOB SUMMARY

The remote CSR position interacts with customers to provide and process information in response to complex inquiries, concerns, and requests about health claims, coverage, benefits, and deductibles.

Projects a professional company image and provides superior customer service by corresponding with Providers, Members, internal and external partners to proactively own the experience and resolve coverage issues.

Resolve claim benefit inquiries by researching and analyzing patient activity and determine appropriate action to be taken. Understands and adheres to all of the client’s administrative and contractual policies and procedures.

Dedicated office space with high speed internet connection required.

ESSENTIAL JOB FUNCTIONS/DUTIES

• Thoroughly and completely document all customer interactions.
• Educates Members and Providers on eligibility, benefits, claims payment, and
• authorizations.
• Provides direction on the usage and benefits of self-service tools.
• Resolve claim benefit inquiries by researching and analyzing patient activity and
• determine appropriate action to be taken.
• Adjusts claims data, when appropriate, to immediately resolve the inquiry and
• maintain first call resolution expectations.
• Appropriately route inquiries to the necessary departments or individuals when
• resolution of the inquiry is beyond the span of control of this role and set follow
• ups.
• Meet or exceed individual, department, and client specific goals. Assist providers
• by resolving coordination of benefits inquiries by analyzing patient activity
• (including enrollment, third party liability, and claims attachments).
• Interpret and communicate accurate insurance coverage by having a
• comprehensive understanding of the process.
• Meet or exceed individual and department goals.
• Understands and adheres to all of the client’s administrative and contractual
• policies and procedures.
• Takes ownership of the resolution and sets expectations for follow up.
• Dedicated office space with high speed internet connection required

QUALIFICATION REQUIREMENTS

• Prior call center / medical experience helpful 1-3 years
• Must have analytical/problem solving capabilities
• Must be PC literate with 10-key proficient
• Excellent oral and written communication skills

EDUCATION REQUIREMENTS:

• High School Diploma / GED (or higher)

Job Type: Full-time

Salary: $17.00 - $19.50 per hour

Benefits:

• 401(k) matching
• Dental insurance
• Health insurance
• Paid time off
• Vision insurance

Experience level:

• 2 years

Shift:

• Day shift
• Morning shift

Weekly day range:

• Monday to Friday

Work setting:

• Call center
• Remote

Ability to commute/relocate:

• Canfield, OH 44406: Reliably commute or planning to relocate before starting work (Required)

Application Question(s):

• The position is remote but requires onsite training for 2 to 6 months in Canfield, Ohio 44406. Would you be comfortable in attending the training onsite?

Education:

• High school or equivalent (Required)

Experience:

• Insurance industry: 1 year (Required)
• Call center: 2 years (Required)
• Medical field: 1 year (Required)

Language:

• Spanish (Preferred)

Work Location: Remote

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